This
is NOT an online buying form - fill it in, print 2 copies,
(1 for yourself and fax/post 1 to us) - Goods will be shipped
upon receipt of payment.
Name & Address Details.
(Use
the Tab key to select the next box)
Your name/Position:
Company
name:
Address:
Postcode:
Tel
No:
Fax
No/Email
Order Details:
Qty
Description
or product codes
Item
Price
Post
Add (£)
postage
UK free
Overseas add £3.00 per order
Goods
Total:
Post
Total:
Order
Grand Total:
Your
Payment Details: I wish to
pay by: (Please choose one)
Cheque
Money
Order
Cash
VISA
Mastercard
Switch
Card
Number:
Cardholder's
Name:
Expiry
Date:
If
Switch please enter Issue date:
I
authorise you to debit £
from the above card.
Payments in British pounds only please - Cheque/money
orders payable to Lakeside Special Products LTD, The
Rubicon Centre, Broadground Road
Lakeside Industrial Estate, Redditch, Worcs, B98 8YP.
England.
Tel. (0)1527 520894 Fax. (0)1527 528465
Email : sales@lsp-needles.com
Signature:
___________________________________ Thank
you for your order.
