PACEXL - ORDER FORM

Order Form

TO:   Cicada Bay Pty Ltd
         P.O. Box 343, Hampton, Victoria, Australia 3188
         Tel/Fax:  61-3-95210319   Email:  info@pacexl.com

Date:         ______________    Title: (Mr, Ms,...) __________

Your Name:   _______________________________________

Postal Address:

Street and Number: _________________________________

City ______________________________ State ___________

Country _____________________ Post/Zip Code ______

Your telephone number: _____________________

Your email address: _________________________________

I am paying for (tick):

[ ]    New order :- Price $Aus 43.70

        No. of copies______   Total $_________

[ ]    Upgrade :-     Price $Aus 29.50

        No. of copies______   Total $_________

I am paying by (tick):

[ ]    Cheque / Money Order payable to Cicada Bay Pty Ltd
        (Print, complete then post order to the above address.)

[ ]    Credit Card
(The responsibility for security with your credit card details is yours!)     (Consider using Fax or Telephone.)

Card Type (tick):

[ ] Visa       [ ] MasterCard         [ ] Bankcard

Card Number: _____________________________________

Expiry Date: _________________

Name on Card: _______________________________