NZ Phone Cards
ABN 34 101 997 175
Suite 18, Level 2, 281 - 287 Sussex St, Sydney NSW 2000
Tel: (09) 8869903
Email: authorization@nzphonecards.co.nz

ORDER FORM
FAX TO:
or mail to the above address


Title:      [  ] Mr    [  ] Mrs    [  ] Miss    (please tick appropriate)

First Name ___________________________    Last Name___________________________________

Home Address: ______________________________________________________________________________

Suburb: ______________    State ______    Post Code______

Email: ________________________________________________________________

HOME Phone: (       ) _____________________ Facsimile: (       ) ___________________

Work Phone: (       ) __________________________


Phone CardQtyPrice
Tiki Talk PhoneCard $10    $    
Tiki Talk PhoneCard $20    $    
Tiki Talk PhoneCard $5    $    
Tiki Talk PhoneCard $50    $    
Chips Phone Card $10    $    
Chips Phone Card $20    $    
Chips Phone Card $30    $    
Phone CardQtyPrice
Chips Phone Card $60    $    
Lucky Phone Card $10    $    
Lucky Phone Card $20    $    
Lucky Phone Card $50    $    
Rocket PhoneCard $10    $    
Rocket PhoneCard $20    $    
Rocket PhoneCard $40    $    
Phone CardQtyPrice
Long White Cloud $10    $    
Long White Cloud $20    $    
Long White Cloud $5    $    
Long White Cloud $50    $    
Total    $    


Payment Details

Credit Card Type:      [  ] Visa    [  ] Mastercard    [  ] Bankcard    [  ] American Express    [  ] Cheque/ Money Order (please tick appropriate)

Credit Card Number: __ __ __ __/ __ __ __ __/ __ __ __ __/ __ __ __ __

CVV/CVC : __ __ __ __ (This is the 3 or 4 digit security code that appears in the front or back of your credit card)

Name (as it appears on the Credit Card) _________________________________

Amount $______________       Expiry Date __ __/ __ __

Authorised Signature: ________________________________