ORDER FORM
 

PLEASE PRINT Fill and  FAX THE FORM TO US.

    Guardian       

        Angel

Postal Address:

P.O. Box 30265 Sunnyside

 0132  South Africa

E-mail: icm@lantic.net

   
               Tel: ( 27) 011- 312 3393
               Fax: 011- 312 4877 
      (0) before 12 if you are dialing out of South Africa
:                www.cure.co.za
 
CLIENT INFORMATION: ( Please use only black pen and write in capital letters)
Name: _________________________ Telephone No:  (      )___________________
Postal Address: ____________________ Fax No: (      )___________________
                       ____________________ Cell No:  ____________________
                       ____________________ E-mail: ________________________

 

In South Africa, advance payment info:  B.Ashoori  ABSA Bank

Saving  Account # 38148180650 Branch Code: 335645

Please fax the deposit slip to: (011) 312 4877       Reference: Name of Invoice to be made out to.

International: Post office money order by registered mail in the name of B.Ashoori to above address to be cashed in Moreleta Plaza post office. You can use a few other international organization as well.

 

It is better to let us know your health problem as well............................................................................

No
ITEM
QUANTITY PRICE    TOTAL
 

 

   

 

 

 

 

 
  Total:  

R 45 shipping charge for orders below R 295. Free shipping in South Africa for orders over R 295. Overseas charges as quoted

Postage:  
Balance due:  

Signature:________________________ Date: ______ / ______ / ________ Place: _________________