REQUISITION FORM - Order No…………..
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NAME:
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DATE:
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ORGANISATION/HOSPITAL:
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ADDRESS:
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TELEPHONE NO:
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EMAIL:
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N.B. – Minimum order $5.00
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PAMPHLETS – WRITTEN BY SANDS (Vic)
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Quantity
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Price
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Total
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SANDS (Vic)
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.30c
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Early pregnancy loss ….. it’s not “just a miscarriage”
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.30c
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Fathers grief….. when a baby dies
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.30c
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Facing subsequent pregnancy… after a baby has died
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.30c
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Making decisions… after the loss of a baby
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.30c
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It’s never too late… if your baby died many years ago
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.30c
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Certificate of Namegiving
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.50c
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BOOKS
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Quantity
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Price
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Total
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“Your baby has died”...(written by SANDS Vic)
* NB. $10.00 each for 1 to 19 copies
$ 6.00 each for 20 to 99 copies
$ 5.00 each for 100 or more copies
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$10.00*
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Our Babies Have Died – collection of 37 stories written by bereaved parents
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$24.95
(Gst inclusive)
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Miscarriage – information booklet for parents & families (Written by SANDS (NSW)
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$2.00
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“Prices subject to change”
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GST 10%
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POSTAGE & HANDLING (via Australia Post)
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TAX DEDUCTIBLE GIFT TO SANDS (Vic) – receipt will be issued
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TOTAL A$
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Bulk purchases are intended primarily for hospitals and funeral directors for free distribution
We will invoice for all orders
Please send order to 208/901 Whitehorse Road, Box Hill Vic 3128
or fax (03) 9899-0219