Order Form

CROSSROADS BOOK PURCHASE

Name 		......................................................		

Date    	..........................

Address		......................................................

	        .....................................P/C...........

Phone No.	......................................................	

I would like to:
* Subscribe to ‘Crossroads News' ($10 pa) 	$..................

* Buy 'Sandy A Butterfly Emerging'  ($10)  	$..................

* Postage per book	($5)                    $..................

* Donation for ICP ($100)			$..................

* Other						$..................

* Give a donation (tax deductible over $2)	$.................. 
(A tax receipt will be provided)	         ===================

			      	Total enclosed	$.................. 



I want to pay by:
* Cash	....	* Cheque / Postal Order .....
	
* Please debit my credit card	VISA....   B/C....   MASTER....  	

Card No	...........................	

Expiry Date    ..............

Name on Card	.................................................


Signature       .................................................





Crossroads NSW Inc.
Suite 2, 265-271 Pennant Hills Road	Email :- xroads@pastornet.net.au
Thornleigh   NSW   2120	Web :- www.pastornet.net.au/crossrds
ABN: 90 070 601 357	Phone:  (02) 9980 8911    Fax: (02) 9875 4002