is NOT an online buying form - fill it in, print 2 copies,
(1 for yourself and fax/post 1 to us) - Goods will be shipped
upon receipt of payment.
Name & Address Details.
the Tab key to select the next box)
or product codes
Overseas add £3.00 per order
Payment Details: I wish to
pay by: (Please choose one)
Switch please enter Issue date:
authorise you to debit £
from the above card.
Payments in British pounds only please - Cheque/money
orders payable to Lakeside Special Products LTD, The
Rubicon Centre, Broadground Road
Lakeside Industrial Estate, Redditch, Worcs, B98 8YP.
Tel. (0)1527 520894 Fax. (0)1527 528465
Email : email@example.com
you for your order.