Name: Surname: Email: Address:
City/Suburb: State: Postal Code: Phone: Fax: Contact me by:
Enquiry:
Phone Fax Email Post
Name of wishing well: Date of function: Venue: Venue Address:
Details of function :
Not sure Grey and white octagonal well Black Wishing Well White Wishing Well Small White Wishing Well Hanging Bird Cage Present Boxes - Random Stack Present Boxes - Wedding Cake stack Present Boxes - off centre stack Present Boxes - 3 of a kind stack Bird Cage Queen Anne Antique Indian Bird Cage Antique Treasure Chest White Treasure Chest Brown Treasure Chest Abstract Modern Wells - white Abstract Modern Wells - Brown Abstract Modern Wells - Long Slimline designer wells - red Slimline designer wells - brown German Boldness Well Italian Romanesque Well Hawaiian Tranquility Well French Elegance Well Asian Inspired Well Bali Beach Hut Well Are you interested in hiring the well
for more then one occasion? Yes No
