Broughton Publishing Pty Ltd
(ABN 1 3098 7137 52)

32 Glenvale Cres
Mulgrave VIC 3170

From:   __________________________________           

            ____________________ Postcode ______

 

ORDER FORM / TAX INVOICE

 

Please supply the following Licences for LabOra e-pray, as listed on the attached Licence Forms, for use in the educational and religious purposes of Christian ministry.

Payment to Broughton Publishing Pty Ltd for these Licence(s) is enclosed.
 

1x Licence (Paid until 1 December in the year of purchase)

 $ 495

GST 10% (no GST for members of the Anglican GST Group)         

 $

TOTAL (payable prior to delivery of e-pray) 

 $ ___
 

Please call 1800 037 729 for payment by instalments.

Payment: forward a cheque payable to ‘Broughton Publications Pty Ltd’ to the above address,
                 or  fill in and sign the following credit card authorisation: 

BankCard  / VISA / MasterCard      (please circle which applies)

qqqq qqqq qqqq qqqq

 

Expiry date: __ / 200_              Name on card: ______________________________________
 
Date: ___ / ___ /  200_            Signature: _______________________________________
 

Please arrange for a First Licence to issued in the name of

Christian Name

Surname

Parish / ministry

Diocese

Street Address

City / Town

Postcode

Phone (BH)
 

Phone (AH)
 

Mobile Phone
 

Email address

I accept the terms and conditions of the Licence Agreement between myself and Broughton Publishing Pty Ltd, including the obligation to pay the annual Subscription fee ($165) for the year commencing December 31 in the year of purchase.

Signed

Date