Print this form out and mail or fax to:

K T Enterprises
4 A Bayview Drive
Waikawa Bay
PICTON   7220

Ph/Fax 03 573 8887
Mobile: 027 655 6930

Name: _______________________________
Address: _____________________________
  ___________________________________
City: ________________________________
Zone: ______ Home Ph: (____)_____ -______
Work Ph:(____)_______-________________
Fax: (_____)__________________________
Mobile: ______________________________
Email: _______________________________

NAME

PRICE EACH BOX

QTY
 TOTAL
 Box of one dozen (12) satchets $  18.00 .  $
. .    $
.
SUBTOTAL
  $
ADD P P & H (NZ)
  $ 4. 00
TOTAL TO PAY
  $

Method of Payment - Major credit card
(Visa or Mastercard) or cheques.

Cheque:
made payable to:
     K T Enterprises

     Tic   Tick box

Card Number: _________________

Expiry date: __________________

Name on card: _________________

Signature: ____________________