Faxed Orders: South Africa

This faxable order form has been included for South African clients who wish to order this book by fax. Please fill out, print, sign and fax this order form to 011-828-9255 (from within RSA).

Item ordered:

Qty	Product / Service	Amount
1 x	Mind of the Super-Achiever	R 150.00
1 x	Shipping Cost: Registered mail included
	Sub-Total	R150.00
	VAT @ 14%	R 21.00
	Total	R 171.00

Destination address...
First name		Last name
Street or Post Box Address		City/Town
State/Province		Zip/Postal Code
Country		E-mail Address
Telephone Number		Fax Number

SECTION B: Credit Card Details...

Credit Card Number

Expiry Date (Format: Month/Year [e.g. 09/99])		Last 3 numbers on back of card
Name of cardholder (as is printed on card)		Card Type: VISA MasterCard American Express

I authorise a maximum of R171.00 (Amount in words: One Hundred Seventy One Rand Only ) to be deducted from my credit card.
Card Holder's Signature: ______________________________ Date: ____/____/____