| |
|
ORDER REQUIREMENTS
| QTY | PRICE | |
| Weight belt (supplied without lead) £ 25.00 | _____ | _______ |
| Please state waist size here ......................................... | ||
Post
and Packing costs: |
_____ | _______ |
| TOTAL ORDER VALUE | _____ | _______ |
Name............................................................................................................................. |
|
Delivery
Address............................................................................................................. |
|
..................................................................................................................................... |
|
Country........................................................ |
Post/Zip
Code.......................................... |
Telephone..................................................... |
Fax......................................................... |
| Email.............................................................. | |
| Mobile............................................................. | |
| Date order placed......../...../...../ | |
| Unfortunately, we aren’t able to offer ordering on line at the present time, but you can pay by the following methods: - |
| 1.
UK residents-cheque (sterling),
banker's draft, MasterCard, Debit MasterCard, Visa Credit, Visa Debit. (Sorry
we don't take Switch!) 2. All other countries - MasterCard, Debit MasterCard, Visa Credit, Visa Debit |
| 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: MASTERCARD / DEBIT MASTERCARD / VISA CREDIT / VISA DEBIT CARD HOLDER NO: |
| CARD EXPIRY DATE _____/_____ |
| CARD HOLDER'S ADDRESS AND POST/ZIP CODE (if different from the delivery address above) |
| ........................................................................................................................... |
| ........................................................................................................................... |
CARD HOLDER'S SIGNATURE.................................................................................. NAME AS IT APPEARS ON THE CARD ................................................................... |
Please complete the above and return to us by one of the following methods:
POST:
ORIGINAL LIZARD