Order form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="02c285a1erlcgo.gif"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>FARMING SUCCESS</B></FONT><B>     |    </B><B> </B><A HREF="index.htm" TARGET="_top" TITLE="FARMING SUCCESS"><U><B>Home</B></U></A></div> <div> <A HREF="about.htm" TARGET="_top" TITLE="About the book"><U>About</U></A><FONT SIZE="1" COLOR="#FFFF99" FACE="Symbol" >   ·   </FONT>Order form<FONT SIZE="1" COLOR="#FFFF99" FACE="Symbol" >   ·   </FONT><A HREF="casestudy.htm" TARGET="_top" TITLE="Case study farmers"><U>Casestudy</U></A><FONT SIZE="1" COLOR="#FFFF99" FACE="Symbol" >   ·   </FONT><A HREF="authors.htm" TARGET="_top" TITLE="Meet the authors"><U>Authors</U></A><FONT SIZE="1" COLOR="#FFFF99" FACE="Symbol" >   ·   </FONT><A HREF="launch.htm" TARGET="_top" TITLE="Launch"><U>Launch</U></A><FONT SIZE="1" 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HREF="agricultural_management.htm" TARGET="_top" TITLE="Agricultural Management"><U>Agricultural Management</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>  Order Form</I></div> <div> <IMG SRC="3e2580a0.jpg" border=0 width="600" height="10" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <div> <I><B> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="4" WIDTH="559" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM COLSPAN=4 HEIGHT= 21 ><NOBR><div> <I><B>Download order form and email to:  </B></I><A HREF="mailto: wimnell@farmingsuccess.com" TARGET="_top" TITLE="mailto: wimnell@farmingsuccess.com"><U><I><B>wimnell@farmingsuccess.com</B></I></U></A><I><B> </B></I></div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="92"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="92" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER ROWSPAN=2 BGCOLOR=#A6CAF0 HEIGHT= 1 WIDTH="77"><div> <I><B>MSWord</B></I></div> </tD> <tD VALIGN=TOP ROWSPAN=2 WIDTH="98"><div>  <a href="HTMLobj-1198/Order.doc"><u>Order1</u> </a>  </div> </tD> <tD VALIGN=CENTER ROWSPAN=2 BGCOLOR=#A6CAF0 WIDTH="105"><div> <I><B>WordPerfect</B></I></div> </tD> <tD VALIGN=TOP ROWSPAN=2 WIDTH="153"><div> <B> <a href="HTMLobj-1199/order1.wpd"><u>Order2</u> </a>  </B></div> </tD> <tD VALIGN=TOP ROWSPAN=2 WIDTH="92"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="92" HSPACE="0" VSPACE="0"></tD> </tR> <tR> </tR> </TABLE></B></I></div> <bR> <div> <I><B>OR:</B></I></div> <div> <I><B>Print this form and fax to +27 (0) 51 401 2557 or  401 3473</B></I></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="652" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP COLSPAN=2 BGCOLOR=#FFCC80 HEIGHT= 15 WIDTH="644"><div> <B>ORDER FORM / BESTELVORM</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 103 WIDTH="311"><div> WIM NELL </div> <div> Agricultural Management Consultant</div> <div> 107 Besselsen Street</div> <div> Universitas</div> <div> Bloemfontein 9301</div> <div> South Africa</div> </tD> <tD VALIGN=TOP WIDTH="330"><div> For attention: Wimpie Nell</div> <div> Tel. +27 (0) 51 522 9510 (H)</div> <div> Cell: 082 882 9777</div> <div> Fax: +27 (0) 51 401 2557/3473</div> <bR> <div> <A HREF="mailto: wimnell@farmingsuccess.com" TARGET="_top" TITLE="mailto: wimnell@farmingsuccess.com"><U>wimnell@farmingsuccess.com</U></A></div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 30 WIDTH="311"><bR> <div> Please send the following books:</div> </tD> <tD VALIGN=TOP WIDTH="330"><bR> <div> Stuur asb die volgende boeke:</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="1" CELLPADDING="4" CELLSPACING="2" WIDTH="651" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 30 WIDTH="66"><div> <B>Quantity</B></div> <div> <B>Getal</B></div> </tD> <tD VALIGN=TOP WIDTH="354"><div> <B>Title</B></div> <div> <B>Titel</B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B>Unit price</B></div> <div> <B>Eenheidsprys</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="85"><div> <B>Total</B></div> <div> <B>Totaal</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER><NOBR><div> STRATEGIC APPROACH TO FARMING SUCCESS</div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="94"><div> R350,00</div> </tD> <tD VALIGN=CENTER WIDTH="85"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="85" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP ROWSPAN=2 HEIGHT= 15 WIDTH="66"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="66" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP COLSPAN=2 WIDTH="452"><div> Postage & Package / Posgeld & verpakking </div> </tD> <tD VALIGN=TOP WIDTH="85"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="85" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP WIDTH="354"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="354" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="94"><div> <B>TOTAL</B></div> </tD> <tD VALIGN=TOP WIDTH="85"><div> <B>      R          </B></div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="4" CELLSPACING="3" WIDTH="609" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP BGCOLOR=#DDDDDD HEIGHT= 30 WIDTH="101"><div> <B>Name/</B></div> <div> <B>Naam:</B></div> </tD> <tD VALIGN=TOP COLSPAN=3><NOBR><div> _____________________________________________________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP ROWSPAN=2 BGCOLOR=#DDDDDD HEIGHT= 15 WIDTH="101"><div> <B>Address/</B></div> <div> <B>Adres:</B></div> </tD> <tD VALIGN=TOP COLSPAN=3><NOBR><div> _____________________________________________________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=3><NOBR><div> _____________________________________________________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#DDDDDD HEIGHT= 19 WIDTH="101"><div> <B>Postal code</B></div> </tD> <tD VALIGN=TOP><NOBR><div> _______________________</div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#DDDDDD WIDTH="64"><div> <B>Tel. no.</B></div> </tD> <tD VALIGN=TOP><NOBR><div> _________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#DDDDDD HEIGHT= 16 WIDTH="101"><div> <B>Cell no.</B></div> </tD> <tD VALIGN=TOP><NOBR><div> _______________________</div> </NOBR></tD> <tD VALIGN=TOP BGCOLOR=#DDDDDD><NOBR><div> <B>Fax no.</B></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> _________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#DDDDDD HEIGHT= 15 WIDTH="101"><div> <B>Epos/Email</B></div> </tD> <tD VALIGN=TOP COLSPAN=3><NOBR><div> _____________________________________________________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#DDDDDD HEIGHT= 30 ><NOBR><div> <B>Signature/</B></div> <div> <B>Handtekening</B></div> </NOBR></tD> <tD VALIGN=TOP COLSPAN=3><NOBR><bR> <div> _____________________________________________________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP BGCOLOR=#DDDDDD HEIGHT= 16 WIDTH="101"><div> <B>Datum/Date</B></div> </tD> <tD VALIGN=TOP WIDTH="169"><div> ____/____/2005</div> </tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="228"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="228" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <bR> <div> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" WIDTH="639" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP ROWSPAN=5 BGCOLOR=#EEEEEE HEIGHT= 74 WIDTH="107"><div> <B>Price of book</B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B>South Africa   </B></div> <div> <B>USA/South America/Canada/Far East</B></div> <div> <B>Europe</B></div> <div> <B>Australia</B></div> <div> <B>Africa</B></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="277"><div> <B>R350.00</B></div> <div> <B>US$ 60.00</B></div> <div> <B>€50.00</B></div> <div> <B>Aus$ 70.00</B></div> <div> <B>US$ 60.00</B></div> </tD> </tR> <tR> <tD VALIGN=TOP ROWSPAN=4 COLSPAN=2 WIDTH="519"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="519" HSPACE="0" VSPACE="0"></tD> </tR> <tR> </tR> <tR> </tR> <tR> </tR> <tR> <tD VALIGN=TOP ROWSPAN=4 BGCOLOR=#EEEEEE HEIGHT= 15 WIDTH="107"><div> <B>Postage and handling fees</B></div> </tD> <tD VALIGN=TOP WIDTH="239"><div> South Africa:</div> </tD> <tD VALIGN=TOP WIDTH="277"><div> R40,00</div> </tD> </tR> <tR> <tD VALIGN=TOP WIDTH="239"><div> International:</div> </tD> <tD VALIGN=TOP WIDTH="277"><div> Postage fees available on request</div> </tD> </tR> <tR> <tD VALIGN=TOP WIDTH="239"><div> Indicate preference: </div> </tD> <tD VALIGN=TOP WIDTH="277"><div> Courier / By air / By ship</div> </tD> </tR> <tR> <tD VALIGN=TOP WIDTH="239"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="239" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="277"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="277" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP ROWSPAN=6 BGCOLOR=#EEEEEE HEIGHT= 59 WIDTH="107"><div> <B>International payments</B></div> </tD> <tD VALIGN=TOP WIDTH="239"><div>         Account:  </div> <bR> </tD> <tD VALIGN=TOP><NOBR><div> WT Nell</div> <div> ABSA  – Brandwag branch</div> <div> Cnr Nelson Mandela/Donald Murray Drive</div> <div> Bloemfontein, South Africa</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP WIDTH="239"><div>         Cheque account no.</div> </tD> <tD VALIGN=TOP WIDTH="277"><div> 1570 178 454</div> </tD> </tR> <tR> <tD VALIGN=TOP WIDTH="239"><div>         Swift code:</div> </tD> <tD VALIGN=TOP WIDTH="277"><div> ABSAZAJJ</div> </tD> </tR> <tR> <tD VALIGN=TOP WIDTH="239"><div>         Sort code:</div> </tD> <tD VALIGN=TOP WIDTH="277"><div> 632005</div> </tD> </tR> <tR> <tD VALIGN=TOP><NOBR><div>         Clearing code or IBAN no.</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="277"><div> 632005</div> </tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=2 WIDTH="519"><div>         All charges outside South Africa for remitter</div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="3" CELLSPACING="3" WIDTH="732" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP COLSPAN=3 HEIGHT= 16 WIDTH="712"><div> <B>METHOD OF PAYMENT / METODE VAN BETALING (Please tick)</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 97 WIDTH="117"><div> <B>Cheque/Tjek</B></div> <bR> <bR> <div> <B>Postal order/</B></div> <div> <B>Posorder</B></div> </tD> <tD VALIGN=TOP><NOBR><div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="38" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></B></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="38" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Cheques must be made out to: WT NELL</div> <div> Tjeks moet uitgemaak word aan: WT NELL</div> <div> Enclosed are the order form and my cheque/postal order for the amount of:</div> <div> Ingesluit is die bestelvorm en my tjek/posorder vir die bedrag van:</div> <bR> <div> R____________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 134 ><NOBR><div> <B>Direct deposit/</B></div> <div> <B>Direkte inbetaling</B></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="38" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 16 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> ABSA</div> <div> Brandwag</div> <div> Cheque Account</div> <div> Account no.   1570 178 454</div> <div> Branch code: 632 005 (Electronic transfers)</div> <div>                          630 734 (Deposits)</div> <bR> <div> Kindly fax the order form and deposit slip to 051 401 2557/3473.</div> <div> Faks asseblief die bestelvorm en depositostrokie na 051 401 2557/3473.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#EEEEEE HEIGHT= 50 WIDTH="117"><div> <B>WEB CREDIT CARD PAYMENTS</B></div> <bR> </tD> <tD VALIGN=CENTER BGCOLOR=#EEEEEE><NOBR><div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="38" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 16 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="16" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#EEEEEE WIDTH="540"><div> <B>VISA & MASTER CARD</B></div> <div> <B>Please supply the following information:</B></div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="117"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="117" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="540" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 30 WIDTH="117"><div> <B>Name of card holder:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>_____________________________________________________________________________</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="117"><div> <B>Tel. no.:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><div> <B>____________________________________________</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="117"><div> <B>Email:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B>____________________________________________________________________________</B></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="117"><div> <B>Type of card:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><div> <B>Master Card ____  Visa ____</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 51 WIDTH="117"><div> <B>Card number:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="533" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></B></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 51 WIDTH="117"><div> <B>Expiry date:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="170" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP BGCOLOR=#000000 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></B></div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 51 WIDTH="117"><div> CVV2 number (Last three numbers on back of card): </div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="104" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="26"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="26" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></B></div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 66 WIDTH="117"><div> Amount:</div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="66" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><div> <B> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="108" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="96"><div> R</div> </tD> </tR> </TABLE></B></div> <bR> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 51 WIDTH="117"><div> <B>Signature:</B></div> </tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP><NOBR><div> ______________________________________________</div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=3 HEIGHT= 51 WIDTH="712"><div> <B>Please print the above form and fax to +27 (0)51 401 2557</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 51 WIDTH="117"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="117" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="45"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="45" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="540"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="51" ALIGN="bottom" WIDTH="540" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div>  <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><IMG SRC="02d0e0e0.gif" border=0 width="14" height="14" ALT="up" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT></div> </td> </tr></table></body>