Nan’s Cottage Garden BOM Registration Form

'Nan’s Cottage Garden’

Block of the Month Registration Form
$35 per month for 10 months
(plus $7.50 tracked postage if required)
Name*

First NameLast Name
Postal Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Daytime Phone Number*

Area CodePhone Number
POST or COLLECT:*

Post ($7.50 tracked postage per month)Collect (from Blue Mountain Heights, QLD)
Our Block of the Months are charged and posted on the 1st Wednesday of each month. All details are securely stored. Once you have submitted your BOM Form, we will be in contact regarding your payment details.

** PLEASE NOTE: by submitting this form, you are agreeing to purchase one block per month for the duration of the BOM program.
Should be Empty:

'Nan’s Cottage Garden’