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Order Form
USA |
| Please print
this form and either fax or post it to the fax No./address at
the bottom of this page |
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|
(BLOCK CAPITALS PLEASE)
Mr/Mrs/Miss/Ms ___________ Name ___________________________________
Address ___________________________________________________________
____________________ Postcode _____________ Country__________________
Your Email Address __________________________________________________
Daytime Telephone No. _______________________________________________
(so that we can contact you immediately with any queries)
Please supply the following
| Style Code |
Description |
Colour |
Quantity |
Total |
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| Delivery |
£9.00 |
| TOTAL |
|
Payment Method ( X )
|
I enclose a Sterling/GBP cheque/postal
order, made payable to "Town and Country Ties". Please write your name and address on the back of the cheque. |
|
Please charge my credit card/charge card (please circle
card)
| Visa |
Mastercard |
Delta |
Maestro |
Solo |
|
| |
Card Number
|
| Expires
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|
Valid From (if available)
|
| Maestro Issue No.
|
Security No.
(last 3 digits in signature area on back of card)
|
| Cardholder’s
Signature_________________________________________ |
| Name on card ________________________________________________ |
| Post to: Town and Country TIes,
PO BOX 3309,
Littlehampton,
West Sussex,
BN16 DY. UK |
| Telephone: +44 1903 782 282 |
Fax: +44 1903 859719 |
Enquiries@CountryTies.com |
|