ORDER FORM

If you would like to order the PRACTICA set, please fill in your details and we will contact you as soon as possible.

Surname*
Baby's Name
Baby's Date of Birth	Day:	Select Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
	Month:	Select Month January February March April May June July August September October November December
	Year:	Select Year 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001
Mommy's Name*
Daddy's Name
Home Telephone	Area Code:	Number:
Mommy's Cell Phone No:
Daddy's Cell Phone No:
Physical Address for Delivery
E-mail address for newsletters:*
Please re-enter -email address to confirm:*
Do you want an English or an Afrikaans set?		Select Language English Afrikaans
Are you paying by Cash or Credit Card ?		Select Payment Method Cash / EFT Credit Card
* Required Fields

PAYMENT METHODS

If you are paying by credit card, to ensure your security we will contact you by phone when we receive your order and ask for the credit card details.

If you are paying by cash deposit / Electronic Funds Transfer, our banking details are:

Name:	Practica
Bank:	Absa
Branch:	Clear Water Mall
Account number:	4060 939 409
Branch Code:	630188
Reference:	Please use your surname followed by C.T.