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Please supply the above items surface/airmail (please delete as appropriate). |
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I authorize you to debit my Visa/Delta/Eurocard MasterCard/Switch/Solo/JCB account with the cost of my order + p. & p. |
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Title..............First name.......................Last name.................................................................. |
Address................................................................................................................................... |
Town/City............................................................................Province/St................................. |
Zip/ Post code.......................................................Country...................................................... |
e-mail......................................................................................Fax........................................... |
Signed...........................................................................................Date................................... |
If you wish to pay by credit/debit card, please also complete card details below. |
Cardholder name...................................................................................................................... |
Card no.................................................................................................................................... |
Issue no/Valid from...........................Expiry ...................................Security code.................. |
Signed...................................................................... .........Date............................................... |