MDHS Order Form

     Your contact details so that we may send your order to you :

First Name
Last Name
Postal Address
City
State
Postal Code
Home Phone

     I  wish to purchase the following:

      Wellington Landscapes   copy/copies at $18   ......................................................... $

      MDHS Bulletin numbers
                                     totaling copy/copies at $2 each   .................................................. $

     Plus postage in Australia:
        please add:  for  Wellington Landscapes: $3.50 for each copy
                           for  Bulletin: 1-3 copies, $1.50; 4-7 copies, $2; each additional copy 50¢                     $ 

     Overseas postage, please ask for a quote here first

     Payment                                                                                            Total due:

        I am forwarding a cheque/postal note for $ made out to Maffra & District Historical Society Inc
                         to the above address

        I  have deposited $   directly into your account  BSB 633 000 126114107
                         (when doing so, please append your surname as reference)