Gallery Shop Mail Order Form*
 *print out and fax or postal mail 		Tel: (613) 9208 0205 Fax: (613) 9208 0201
Mail: Gallery Shop, 180 St Kilda Rd, Melbourne, VIC 3004, Australia
Qty
Code
Description
Price
Total
Method of Payment Cheque (payable to National Gallery of Victoria)
American Express Mastercard Visa Bankcard Diners Club

Cardholder's name: (please print)

Address:
Postcode:
Credit Card Number:
Expiry Date:
Deliver to:
Name:
Address:
Telephone (BH):
Telephone (AH):
Mobile:

Discount: National Gallery of Victoria Society members receive a 10% discount on most purchases. To obtain a discount, please print your membership details below:

         
         
         
         
         
         
         
         
         
Postage and Handling
Within Australia:
Aus $7 for orders up to $50; $12 for orders over $50
International: US $29.50 airmail to the States
International price on application (email :enquiries@ngv.vic.gov.au) 		Subtotal  
Postage  
Total