The Australian Three Peaks Race®

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MERCHANDISE ORDER FORM

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Merchandise Description Page

Please print the order from your screen,
complete and sign it then post to:

Hydro Tasmania Three Peaks Race
10 Aotea Road
Sandy Bay, Tasmania 7005
Australia.

Fax: +61 (0)3 62254974

Name:___________________________________________________________

Address:________________________________________________________

____________________________________________ Post Code__________

Email:__________________________________________________________

Payment method: Cheque_______ enclosed or

Visa_______

Mastercard_______ (Circle one)

Card Number:_______ _______ _______ _______ Expiry Date: ____ /____

Full Name as shown card_____________________________________________

Signature______________________________________ Date:______________

Description	Size	Qty	Price	Total
				$
				$
				$
				$
				$
				$
				$

Plus postage & handling $_____________

Total $_____________

Delivery Instructions:_________________________________________________________

_________________________________________________________________________

Thank you for your order

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