Labels:text | screenshot | font OCR: SUBSCRIPTIONS Please send me: 1 x 12 month subscription @ $150=$ 1 x 6 month subscription @ $ 80= $ x back issue # @ $14.95 ea = $ TOTAL =$ Name: (credit card payments - list name as appears on card) Address: (credit card payments - list home address, not business or PO box) postcode Phone: _(BH) (AH) Email Please charge my (tick): Mastercard Visa Bankcard Credit card number: Card valid from: ---- to - -- ---- -- -- Signature: Please make cheques payable to: Robot Madness Pty Ltd Send payment and this form to: THE DISC SUBSCRIPTIONS ROBOT MADNESS LEVEL 2, 11-17 DORCAS STREET SOUTH MELBOURNE VIC 3205 Fax: 03/ 9690 8337
