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  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.
Login Name first choice: ...............................................................
Login Name second choice: ...............................................................
Login Name third choice: ...............................................................
Password: ...............................................................
Step 2:Personal details
First name: ...............................................................
Surname: ...............................................................
Addressing details  
Street Name and Number: ...............................................................
City/Town: ......................................................... State: ...........................
PostCode/Zip code: ...............................................................
Country: ...............................................................
Phone Number: ..................................... Fax Number: .....................................
Email Address: ...............................................................
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: ...............................................................
Card Number: ...............................................................
Card Type :    
Card Expiry Date:
...............................................................
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