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Complete this page, print out and fax to 0871 288 5746 or post to:-
Garden Supply Direct Ltd |
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| Customer details : | |
| Name | |
| Address | |
| Postcode | |
| Telephone | |
| Account Number (if applicable) | |
| Order details : | ||
| Item Product Code & Description | Quantity | Total (£) |
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| £ | ||
| Total value of Goods | £ | |
| Postage and Packing | £ | |
| Total amount Paid | £ | |
| Payment details : | |||||||||
| Payment method (Make Cheque / Postal Order payable to 'Garden Supply Direct') |
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| Card Type |
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| Card Number | |||||||||
| Security / CV2 code | |||||||||
| Valid from date | / (mm/yy) | ||||||||
| Expiry date | / (mm/yy) | ||||||||
| Switch Issue No. | |||||||||
