BASE PANTS
ORDER FORM

The diagrams show our standard layout ... if you want something different, contact us and we'll be happy to quote for the extra work involved - any design considered!!

ORDER REQUIREMENTS

	QTY	PRICE
Fitted design £130.00	_____	_______
Knee re-enforcement panels £ 10.00 (pair)	_____	_______
Leg pocket £ 5.00 each	_____	_______
Additional colours £ 5.00 per colour	_____	_______
Custom/Additional work P.O.A	_____	_______
Post and Packing costs: UK Mainland and BFPO £4.00 , Europe £6.00, Rest of the World £9.00	_____	_______
TOTAL ORDER VALUE	_____	_______

DESPATCH AND PAYMENT DETAILS

Name.............................................................................................................................
Delivery Address.............................................................................................................
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Country.........................................................	Post/Zip Code..........................................
Telephone.....................................................	Fax.........................................................
Email................................................................
Mobile...............................................................
Date order placed......../...../...../

Unfortunately we aren’t able to offer ordering on line, but you can pay by the following methods: -

1. UK residents-cheque (sterling), banker's draft, Master Card, Visa Card, Delta Card (Sorry we don't take Switch!) 2. All other countries - Master Card, Visa Card, Delta Card

I enclose a Cheque for the full order value of £ _____________ Made payable to ORIGINAL LIZARD Or: Please debit my credit card the amount of £ ______________ Credit card details: MASTER CARD / VISA / DELTA CARD HOLDER NO:

CARD EXPIRY DATE __/__/____

CARD HOLDER'S ADDRESS AND POST/ZIP CODE (if different from the delivery address above)

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CARD HOLDERS SIGNATURE..................................................................................

Please complete the above and return to us by one of the following methods:

POST: