D70 Supplies Order Form  
     
Please complete this form to order supplies from the District 70 Supplies Officer,
charging the cost to a credit card. Note that this is not an e-commerce action.

When you submit the form, you will be shown a page confirming your data entry.
This data is not stored on our web server or any other computer. Rather it is sent as a text
email message to District 70, where it is printed and processed along with registrations received
by post or fax. If you wish, you can avoid having your full credit card number appear in the email
message sent to us from the form by following the procedure explained at the bottom of this form.

If you need to correct any details, please send a follow up email to the Supplies Officer.

Please provide the following details for your order:

Club Name
Club Number  
Attention
Address
Address (cont.)
City or Suburb
State
Postcode  
Phone   Home Work Mobile (select one)
Email  

Please provide details of items required:

Quantity Cat. No. Description Unit
price		 Total
price

  Sub Total:
Add Postage and Handling @  10% (minimum $2.50):
 

Total payment due:

Please provide details of payment:
(Note that minimum order charge is $5.)

Payment method

Credit Card
Cardholder Name
Card Number Please leave spaces between each group of 4 numbers.
Expiration Date
Amount to be charged

Note: If you are concerned about your credit card number appearing in an email message, then include only the first 8 digits in the box above. After submitting this form, follow it up by sending an email to the Supplies Officer giving your name and the remaining digits on your credit card.

                    

Go back to District Supplies page
Toastmasters International District 70
Revised: 04 Apr, 2008