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This is not an automated form. You need to
print it, complete your details and send it to Rupert’s Ridge by fax on
(03) 5425 3297 or by email to rupertsridge@bigpond.com
or by mail to Rupert’s Ridge,
PO Box 62, Redesdale VIC 3444. Name
____________________________________ Preferred Contact Number
____________________ Email
Address _________________________________ Delivery
Address
_____________________________________________________________________________ Postcode
_________ Delivery
Instructions
____________________________________________________________________________________________
Expiry Date ___ / ___
Name on Card _________________________________________ (Please use
BLOCK LETTERS)
Signature
____________________________________________ Rupert's Ridge ABN 62 887 817 010
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