<---Go Back to Migrant Ships Print this form out, complete it and fax it to us at Delft Blue Pottery. Your name: Mr./Mrs./ Miss______________________________________ Your address:________________________________________________ __________________________________________________________ Town:______________________ State:_____________________ Postcode:__________________ Your Telephone number and area code Home__________________________ Bus.____________________ PLEASE PRINT CLEARLY ALTERATIONS ARE NOT POSSIBLE Names and the ages of your family on board_______________________________________ _________________________________________ _________________________________________________________ ___________________________ _________ Port of departure:____________________ ______________________________ Date of departure:____________________ ______________________________ Name of the ship__________________________ ______________________________ Dit you go via Suez Canal-------Panama Canal-----or Cape Town?-------- Port of arrival:____________________________________________________ Date of arrival:_________________________________________________< Number of unframed photos_______ Colour or Black and white __________________ If you wish to send the photo direct to the recipient, please supply the following details. Name of the recipient: Mr/Mrs/Ms/Miss/_______________ ___________________________ ___________________________ Town:_________________State___ _________________Postcode__ Post your order with payment to: Delft Blue Studio, 235 Forest Road (Cnr. Harcourt Road) Boronia 3155 Victoria. Fax/Tel: International+61 3 97621784. Australia 03-97621784 E-Mail to: office@delftbluestudio.com Card Holder number______________________________________________________ _________________________________________________________ Expiry date________________________________________________________ Bankcard______________Master Card_______________ Visa Card_________________________ Signature___________________________________________________ Name and address_____________________________________________________ Telephone:__________________________________________________ Description of goods:________________________ Cost of goods_______________________________________________________ (Including Postage Economy/Air) Australia$_______________________________________________ A 5% surcharge will be applied for Credit card payments.Debit cards not acceptable. ___ <-------Go Back to Migrant Ships