| Le Prevo Limited |
No.1 Charlotte Square, Newcastle upon Tyne, NE1 4XF
Tel: 0191 232 4179 Fax: 0191 261 7648 |
Order Form |
| Name: | Date Of Order: | |
| Address: |
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| e-mail: | ||
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| Postcode: | Country: | Telephone: |
| Quantity | Order Code | Description (colour, size etc) | Price / each | Total |
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| Total Goods |
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| Carriage | ||||||||
| Sub Total 1 | ||||||||
| VAT @ 17.5% | ||||||||
| Sub Total 2 | ||||||||
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credit card 2% |
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| GRAND TOTAL |
minimum goods order
value £10.00 |
Method of Payment
Cheque / P.O in UK Sterling enclosed for £.................
Open Cheque in UK Sterling enclosed not exceeding £................
Please charge my debit card (no surcharge)
Please charge my credit card (2% surcharge)
| Expiry Date |
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Issue No / Valid From |
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Security Code |
| I have read and accept your trading terms |
In case we cannot complete your order, please tick
as appropriate |
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Substitute as near as possible |
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| Signature ................................................................................ |
Cancel |