NB: This is not an Online Form
Automatic Deliveries Form
Change of Details Form
To Register please copy/print, complete and return to Eco-Organics
Internet Banking Customers - please register by email copy, complete and send to firstname.lastname@example.org
Credit Card Customers - register by email or post copy, complete and send to email@example.com or post to Eco-Organics 153 Ararimu Valley Rd, RD2, Waimauku, Auckland 0882
|Home Phone Number:|
|Work Phone Number:|
|Mobile Phone Number:|
|E-mail: please write clearly|
|Special Delivery Instructions - N.B. Deliveries will be automatically left at the door. If you require otherwise or if further details need to be included please specify:|
We accept payment by credit card, cheque, advanced payment and internet banking.
Our preferred method of payment is internet banking. Internet banking details and your personal shopping code will be supplied upon registration.
Credit Card Details If paying by credit card please fill out the following:
Type: Visa MasterCard (please circle)
|Card Holder's Name:|
|Card Holder's Signature:|
I authorize Eco-Organics to charge my credit card with the total amount payable, including courier fee, for each and every order I place with Eco-Organics until and unless I notify Eco-Organics differently.
N.B. All online shopping and emailed orders must be paid by internet banking, credit card or advanced payment, and postal orders must include payment with order.
Internet Banking and Credit Card Customers please copy/print this form and return via email or post.
153 Ararimu Valley Rd
Phone: (09) 411 8466
You will receive a personal shopping code as soon as your registration is processed.
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