* * *  H A M   L O G  (v.3)  * * *

                   * * *  O R D E R   F O R M  * * *

 TO:  Mr. Robin Gandevia,    Telephone: Intl: 61 2  (Local: 02)  369 2008
      74 Carrington Rd.,     Fax:       Intl: 61 2  (Local: 02)  369 3069
      WAVERLEY  NSW  2024
      AUSTRALIA

             * * *  ALL AMOUNTS IN AUSTRALIAN DOLLARS  * * *

 Please supply the following registered copies of HAM LOG:-

     ___  copies       @ $59.00       $ _____.___   (approx. $45.00 US)

   Shipping and Handling (AIR-MAIL):-
    Australia          $5.00  per copy
    New Zealand        $8.00  per copy
    Other Countries   $11.00  per copy $ _____.___   (approx. $8.00 US)

      ___  copies       @ $            $ _____.___

                      SUB Total:       $ _____.___

                             TOTAL AUD $ _____.___  (Australian Dollars)


    Full Name: ________________________________________________________

    Address:   ________________________________________________________

    City:      ____________________  State: _______  Zip: _____________

    Country:   ____________________    CALL SIGN:  ____________________

    Phone:     ____________________    Fax:     _______________________

    DISK FORMAT and SIZE:  ____________________


 Payment Method:-

    MASTERCARD _____     VISA _____     Bankcard _____     Cheque _____

    Card Number:  _____________________________________________________

    Expiry Date:  _____________     Signature: ________________________


    Please make cheques payable to:- ROBIN GANDEVIA (Australian $ Only)

 NOTES:: If ordering more than one copy, please supply the full user
         details for EACH copy, as well as disk format / size.
 Simple method of ordering from overseas is fax and credit card.
 Cheques may also be payable to: Dr. Hi Fi Pty Ltd.   (ACN 002 266 239)

             YOUR ORDER WILL BE DESPATCHED THE SAME DAY BY AIR