ORDER FORM
 

PLEASE PRINT, Fill and  FAX THE FORM TO US.

    Guardian       

        Angel

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

email: icm@lantic.net

   
               Tel: ( Country code 27)-011- 3123393
               Fax: 011-312 4877  ,  086- 502 3233 
      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: 632005 Please fax the deposit slip to: (011) 312 4877     

Out of South Africa can pay PayPal   icmsa@telkomsa.net 

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............................................................................

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 QUANTITY PRICE    TOTAL
 

 

    

 

 

 

 

  
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R 35 shipping charge for orders below R 295. Free shipping in South Africa for orders over R 295. Overseas charges as quoted. Please check the prices if VAT is not included add VAT. By ordering from our company means you have agreed to all sales condition on this web site. ( no refund )

 Postage:  
Balance due:  

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