'ULTRASCALE PRODUCTS' (Manual Order Form) Reference: GSL0208W
Date: 16/05/2008 Sheet ____ of ____
Delivery details
Name:
Address:
 
 
Town/City:
County/State:
Post/Zip Code:
Country:
Credit Card details (if different from delivery)
Name:
Address:
 
 
Town/City:
County/State:
Post/Zip Code:
Country:
Telephone Number: Customer No (if known):
Email Address:
DESCRIPTION / ADDITIONAL INFORMATION / OPTIONS GAUGE QTY PRICE
EACH		 SUB
TOTAL
         
         
         
         
         
         
         
         
         
         
Payment Details
Cheque:
 
  Postal Order:
 
  International Money Order:
 
Number: ______________________________________

Please make above payable to "Gear Services (Letchworth) Ltd."
MasterCard:
 
  Visa:
 
  Maestro:
 
  Solo:
 
  American Express:
 
Card Number:
                                     
Valid From:
    /    
  Expires End:
    /    
  Issue: (Maestro)
   
  Security Code:
     
(if present, the Security Code is the last 3 digits of the number printed on the signature strip on the back of the card)
 
Bank that issued card:_______________________________
 
Signature:_________________________________________
NOTES TO CUSTOMERS
  • Please sign all card orders.
  • Please note, we only accept UK-issued Maestro cards.
  • Please use block capitals and keep a copy of the order.
  • Any details that are missed out or are unclear will delay the processing of this order.
Total This Sheet:  
Credit Note No:  
Debit Note No:  
Postage and Packing:  
TOTAL ORDER CHARGE:  
FOR OFFICE USE ONLY
Date Received:
Date Completed:
Authorisation Number:
Please send all orders to:
Gear Services (Letchworth) Ltd.
Unit 25,
Such Close II Industrial Estate,
Letchworth Garden City,
Hertfordshire,
SG6 1JF.
United Kingdom.
Tel: +44 (0) 1462 681007
Fax: +44 (0) 1462 681577
 

Form No.: MOF070930