ORDER FORM

Earle Otway Regalia Officer P O Box 6077 Brookfield, Tauranga 3146 New Zealand

Phone:  +64 7 576 7178 email: Earle Otway

I wish to order the following Austin Healey Car Club of New Zealand merchandise indicated by the quantity in the appropriate boxes:

NAME

DELIVERY ADDRESS

EMAIL

PHONE

ITEM	COLOUR	PRICE	M	L	XL	XXL
POLO SHIRT MEN	Black	$30
VEST MEN	Black	$50	N/A
ITEM	COLOUR	PRICE	12	14	16	18
POLO SHIRT WOMEN	Black	$30
VEST WOMEN	Black	$50
ITEM	COLOUR	PRICE	ONE SIZE
CAP	Black	$25			KEYRING		$10
BEANIE	Black	$15			LAPEL BADGE		$7
					JACKET PATCH		$7
VISOR	Black	$15			LONGBRIDGE GRILLE BADGE		$25
NZ POSTAGE		$5			KIWI GRILLE BADGE		$25

Please complete, print and post with payment to the above address
Please add $NZ5.00 Postage and Packaging - Overseas Postage on application