| ORDER |
1
Delivery Address
(If different from invoice)
orders -
half price
|
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| Order Form | |||||||||
| Invoice Address 1 |
Delivery Address |
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| Name: | Name: | ||||||||
| Establishment Name: | Establishment Name: | ||||||||
| Address: | Address: | ||||||||
| Postcode: | Postcode: | ||||||||
| Telephone: | Telephone: | ||||||||
| Fax: | Fax: | ||||||||
| E'mail: | E'mail: | ||||||||
| If you wish to pay by credit/charge card, please complete the following details | Cardholders Name: | ||||||||
| Card Type (e.g. Visa/Delta) | |||||||||
| Pre-paid | Security Number: | ||||||||
orders - |
Card Number: | ||||||||
half price |
Start Date: | ||||||||
| Expiry Date: | |||||||||
| Issue No. for Switch: | |||||||||
| Special Instructions | |||||||||
| For Order :- | |||||||||
| Item Code | Description | Colour/Size | Unit | Quantity | Unit Price | Total Price | |||
| Goods Total | |||||||||
| Carriage | £6.50 | ||||||||
| VAT @ 15% | |||||||||
| Total | |||||||||
| Hemming Healthcare, 91-93 Bailiff St. Northampton. NN1 3EA E-mail: info@hemminghealthcare.com | |||||||||
| Fax 01604 620002 Call 01604 634289 | |||||||||
| Hemming Healthcare is a trading name of Hemming Visual Aids Ltd. | |||||||||
| Company Registration no: 1941181 | |||||||||