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Agranova Order
Form
Please refer to the Price List for current pricing.
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Use this form to mail your order. For faster service,
fax or e-mail :
Agranova, 34 The
Drive, Orpington, Kent BR6 9AP, UK
tel: +44 1689 600
501
fax: +44 1689 897 786
e-mail: agranova@compuserve.com |
| Order Date : |
Please write clearly - use BLOCK CAPITALS ! |
| Title/Name
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| Company :
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| Address :
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| City :
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| Tel :
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| e-mail :
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Code |
Description
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Qty. |
Unit
Price |
Total |
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| Cheque enclosed |
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| Bill
me later |
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Visa / Mastercard (see below) |
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<< Select method of payment
Mailing is free for all pre-paid orders. Shipping
and handling costs will be added to the invoice for all billed and proforma
orders. Payment may be made using Visa and Mastercard (see below) in US Dollars (USD) or
in Pounds Sterling (GBP) or by cheque in either of these currencies:
USD cheques must be drawn on a US bank and made payable to Dr.R.J.Bryant .
GBP cheques must be drawn on a UK bank and made payable to Agranova. |
For Visa and Mastercard purchases, please fill in ALL of the details below:
| Card (circle type): |
Visa |
Mastercard |
| Card number :
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| Expiry Date :
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3-digit security code :
(on the strip on the back of card)
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Cardholder Name
as written on card |
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Card Address
house no., street
and ZIP code are required |
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| Amount:
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(specify currency) |
| Signature
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