ORDER FORM
 

PLEASE PRINT, Fill and  FAX THE FORM TO US.

    Guardian       

        Angel

 Postal Address: P. O Box 30265 Sunnyside 0132  South Africa

email: ashoori@lantic.net

   
               Tel: ( Country code 27)-011- 3123393
               Fax: 011- 312 4877 
      no( 0) before 12 if you are dialling out of South Africa
:                www.cure.co.za
 
CLIENT INFORMATION: ( Please use only black pen )
Name: _________________________ Telephone No:  (      )___________________
Postal Address: ____________________ Fax No: (      )___________________
                       ____________________ Cell No:  ____________________
                       ____________________ e-mail: ________________________

 

In South Africa, advance payment info:  B.Ashoori  ABSA  saving  Ac# 38148180650 Branch code: 335645 Please fax the deposit slip to: (011) 312 4877      

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 organisation as well.

 

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

No
ITEM
 QUANTITY PRICE    TOTAL
 

 

    

 

 

 

 

  
  Total:  

R 35 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: _________________