AVON FAX ORDER FORM

70 Grayston Drive, Sandton,2196 Please Fill Form

P.O. Box 391120 Bramley 2018
Fax Order Form to
in BLACK PEN
Telephone: 0860 10 23 45 ONLY!! (035) 753 4855

District Account Number Campaign

First Name Mailplan

Surname No of
Customers

Delivery Mode : Door to Door Door to Counter

Delivery Address:
Building Name,
House No.
& Street
Suburb

Town
Date

Postal Code GSL Code or Name

Is the above address your PERMANENT DELIVERY address? YES NO (Mark with a cross)

Telephone Numbers

0 0
(Cell Phone number) (Home or Business Number - including dialling code)

Brochure Brochure
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Total Value of your order is
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- Signature
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