FIVE POLE FARM

po box 5005, Moulton, Northampton, NN3 7ZU

fax/phone (01604) 493578

U.K. Order form June 2002

YOU MAY USE THE SUBMIT BUTTON AT THE BOTTOM OF THE FORM

OR IF YOU PREFER, FILL IN THE FORM, PRINT USING THE PRINT FACILITY ON YOUR BROWSER

AND FAX OR POST TO US AT THE ADDRESS ABOVE

note: if printing this form, adjust your print settings to ignore the background colour (it will save you a lot of ink and also be clearer).

internet order

HAVE YOU BOUGHT ONE OF OUR PRODUCTS BEFORE ? (Required)

HAVE WE WRITTEN TO YOU(Required)

WHERE DID YOU HEAR ABOUT US ?(Required)

KEY RING..........................................KR.jpg (3265 bytes)

Titfer Fridge Magnet.............................titfer.jpg (2435 bytes)

two titfers & weed magnet set...............titferset.jpg (3657 bytes)

iron on transfer for t-shirts....................lgp t,shirt NO SIGN.jpg (95418 bytes)

iron on transfer for t-shirts....................lgp t,shirt NO SIGN.jpg (95418 bytes)

POT THE DOG ...................................sdthmb.jpg (1708 bytes)

TORTOISE .........................................stthmb.jpg (1930 bytes)

SEATED MAN ...................................SMOVALthmb.jpg (3082 bytes)

MRS POT ...........................................swthmb.jpg (2976 bytes)

2 SEATED MEN + WEED .................smmthmb.jpg (2364 bytes)

1 SEATED + 1 STANDING + WEEDsmwthmb.jpg (2452 bytes)

2 STANDING + WEED..................... sww.jpg (14489 bytes)

12" BODDINGTON...there are delays with this figure..bodthmb.jpg (2822 bytes)  

.. PLEASE  SHOW TOTAL ORDER VALUE £(Required)

TITLEFIRST NAME

LAST NAME 

   PHONE 

ADDRESS

ADDRESS

ADDRESS

ADDRESS

ADDRESS

POST CODE

E-MAIL

TYPE OF CREDIT/DEBIT CARD or requests for us to telephone you for your card details

ISSUING BANK

CARD NUMBER

EXPIRY DATE            VALID FROM

SECURITY NUMBER FROM BACK OF CARD (LAST 3 NUMBERS ON BACK)

ISSUE NUMBER IF APPLICABLE

Please feel free to enter any comments or additional information in the box below

 

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