DLRA MAIL ORDER FORM
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Personal Details
Please tell us who you are (red denotes required information):
| Name |
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| Email
(Your confirmation will be sent here): |
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| Other Contact Info: |
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Payment Details
| Name on Card |
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| Type of Card |
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| Card Number |
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| Card Expiry (##/##) |
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| Security Code (3 numbers on back of card) |
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Shipping Details
| Name |
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| Street or PO Box |
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| Suburb |
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| State |
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| Country |
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| Postcode |
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All items are subject to availability, please contact us prior to placing order.
Prices shown are in Australian Dollars. Postage is extra, contact us to confirm.
Payment can be made by Visa and Mastercard, personal cheque, postal order or bank draft. Do NOT send cash.
Please send your orders to;
DLRA Merchandise
P.O. Box 349,
Castlemaine VIC 3450
Ph: 03 5472 4629