Mastercard or Visa

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Cardholder Name: .......................................................................

Card Number: .......................................................................

Expiry Date .............................

� MasterCard � Visa

Cardholder Signature .......................................................................

Send to Geoffrey Lewis

e-mail glewis@custom-made.com.au

fax : +61 2 9398 5010

Credit card amount will be billed in Australian dollars. The merchant name on your credit card statement will be Custom-Made Software Pty Ltd.

Because of exchange rate fluctuations the amount billed to you could differ slightly.

Order details

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