UNIYA - Order Form
                                   
           I wish to order the following books/papers/cards
                                   
               Please PRINT this form and send order to:
                           
                           Uniya
                           PO Box 522
                           Kings Cross NSW 2011
                           
 NAME: (Please print) ____________________________________________
 
 ADDRESS: ________________________________________________________
 
 _______________________________________________ Postcode ________
 
 
 NAME OF BOOK/PAPER                                      Cost
 
 _____________________________________________________ $ _________
 
 _____________________________________________________ $ _________
 
 _____________________________________________________ $ _________
 
 _____________________________________________________ $ _________
 
 _____________________________________________________ $ _________
 
 _____________________________________________________ $ _________
 
                                       + 20% postage   $ _________
 
           I enclose a cheque/money order for: TOTAL   $ _________
 
 (Cheques made out to "Uniya")   OR
 
 Please debit my Credit Card  [please circle]
 
                 Mastercard  Bankcard  Visacard
 
 Card Number _________ : _________ : _________ : _________
 
 Expiry Date _______________
 
                   Signature _____________________________
 
 (Cardoner on VicNet, May 95)