Please print this order form and either send it to Rob Harvey,
Kookaburra House, Gravel Hill Rd, Holt Pound, Farnham,Surrey, GU10 4LG
or fax it to 01420 23078 with credit card details

 Date.................................. Name.......................................................................

 Address..............................................................................................................

 ...........................................................................................................................

 ...................................................................Post Code.......................................

 Tel.................................................... Fax...........................................................

 email...................................................................................................................

 Description

 Price

 Quanity

 Total
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Sub Total  
  
Carriage is £6.95 for most UK post codes -
 £6.95
Total -
 ______

Please fill in the credit card details below

 

Card holders Name..................................................................................

Card Number...................................................Expiry Date.....................

Valid from.......................Type of card.....................................................

3 digit security number:...................... Issue number: ..................
(This number can be found on the back of the card, near the signature)

The card must be registered at the delivery address. If you need to have the goods delivered elsewhere, please contact the office