Post or Fax this form for Oz Matilda Bear Co Membership

Oz Matilda Bear Co., est.since 1994™
P.O Box 366 Crabbes Creek, NSW Australia.
Ph/Fax:0266771388 email: info@ozmatilda.com.au

This form is for manual processing. Just print out this form and Fax it to Oz Matilda Bear Co., or post it with a membership cost of $65.00 australian dollars and Oz Matilda Bear will process your membership straight away and return your login name and membership number to you by which ever method you choose so that you may begin enjoying our exclusive bears as soon as possible.

step 1:Choose your login name and password.
Because no two login names can be the same please specify 3 possible login names in case your first pick is not available. Your login name should be no longer than 12 characters and be all lower case.

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Password:

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Step 2:Personal details

First name:

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Surname:

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Addressing details

Street Name and Number:

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City/Town:

......................................................... State: ...........................

PostCode/Zip code:

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Country:

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Phone Number:

..................................... Fax Number: .....................................

Email Address:

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Step 3: Specifiy how you wish to be sent your Login Name and member Number

Email:

Fax:

Normal Mail:

Specifiy how you are paying the membership cost:

Credit Card

Personal Check

Money Order

If by Credit Card Fill out the fields below

Name on Card:

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Card Number:

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Card Type :

Card Expiry Date:

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Membership Period:

1 Year

Cost

AU$100.00

Oz Matilda Bear Co., est.since 1994™
P.O Box 366 Crabbes Creek, NSW 2483 Australia.
Ph/Fax:0266771388 email: info@ozmatilda.com.au
Oz Matilda Bear Co.,™ ©2001 Design by UAC Media