Printable / Fax Back Order Form
Name:
Address:
Telephone
E-mail
Item Description
Ref
No
Quantity
Total
Please contact us for shipping
/ delivery charge
VAT
TOTAL
Card
Holders Signature
Card
Holders Name
Card
Type
Switch
Delta
Visa
Mastercard
Card Number
please double check the number
*Card
verification number
the three digit number after the long number on the signature strip
Issue
number
on some switch debit cards
*Valid
From
*Expiration
Date
Have
you ever ordered from us before ?
invoice number if you have it
Delivery
address if different from billing address
Name:
Telephone
Delivery Address:
Please give as much detail as possible to avoid delivery delays
Smithy Lane,
Holmeswood, Ormskirk, Lancashire, L40 1UH... Tel / Fax: 01704 821136 (9.00
till 5.00)....
E Mail : sales@bins-n-benches.co.uk
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