Dminish New Zealand

		*Order Form* *for bank transfer*
		*Complete the following form to place an order for your Decollette Pads or use Paypal (Buy Now button) on the home page*
		First Name:
		Surname:
		Address:
		Postcode:
		Phone no:
		Email:
		Qty Required:
		Amount:
		Payment:	Cheque Bank Transfer Cheques: Payable to S.J. Thomas Post to: 17 Kahia Lane, RD1, Redvale, Albany, Auckland 0792 Bank Transfer: Pls deposit money into ASB Bank Acc No:12-3055-0237041-01 Payable to: S J Thomas
		Order Ref:	(email address or name as Bank Ref)
		Message: