To:       Laptopbits Ltd
            Midge Hall Farm
            Midge Hall Lane
            Midge Hall
            Lancashire  PR26 6TN
            United Kingdom
 
 

ORDER FORM
 
Customer Name:                                            Company Name:
 
Telephone Number(s):
 
Card Holder and Delivery Address (please include postcode):
 
 
 
Card Number:
 
Card Start Date:                        Card Expiry Date:                            Card Issue No:
 
Please supply the following items:
 
Quantity Item Description                                                      Price Ex VAT  VAT (UK  only) Price inc VAT 
       
       
       
       
       
       
       
       
      Net Price  
  Note:   Carriage  
  If ordering more than one item please contact us for total shipping price as this will usually be cheaper.   Total Price  
 
 
I authorise Laptopbits Ltd to debit my chargecard/creditcard/debitcard for the total amount shown above in
respect of the listed items and confirm that I am an authorised signatory.
 
 
Signed:                                                       Date:
 
 
Please fax to 01772 455366 (overseas: +44 1772 455366) or post completed form with cheque to:
Laptopbits, Midge Hall Farm, Midge Hall Lane, Midge Hall, Lancashire United Kingdom PR26 6TN
We have deliberately kept this form simple to avoid printing problems.  If you prefer to use your own purchase order form please do so.