BOM Registration

2012 Blocks of the Month

Beginning January 2012 Country Hart will be offering 4 BOM programs

                   I..............................................................................................

Address:......................................................................................................................................

.................................................................................................State:............Postcode:..........

Wish to participate in

                    Lynette Anderson’s In Full Bloom BOM @ 21.75 per month for 6 months

             Teddlywinks Grandma and me BOM @ 26.50 per month for 6 months

                     Gail Pans Homecoming Lane @ 50.00 per month for 4 months

                     One Day in May’s Thankful @   $39.50 per month for 6 months

I agree to Country Hart Designs debiting my credit card .................... + postage if applicable per month for ...............months

Signature:.................................................................................................................

Credit Card Details

Number on Card:  ................  ...............  ............... ...............

Name on Card: ......................................................................

Expiry: ................................CCV.......................................

You can either email your completed form to countryhart@bigpond.com  or print it off and mail it to

Country Hart Designs

Shop 3/176 Ellen Street

Port Pirie 5540 SA or you can drop it into the shop personally

Cheers

Robyn