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Use this form when ordering by fax.
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Fax this form to: 0033 296 215597 (Nezert Books) |
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Delivery Address Detail |
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| Name | Address |
| City/Town | County/State/Province |
| Postal/Zip Code | Country |
| My Fax No. | My Telephone No. |
| My Email Address. | |
| Product Name | Price | Qty | Total Value |
|---|---|---|---|
| One-to-One A Practical Guide to Learning at Home | |||
| Postage and Packing | 00.00 | ||
| Grand Total £ | |||
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Price Guide: Price per book:
£12.50 (U.S. $19.95) |
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| PAYMENT DETAILS | ||||||
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| Credit Card Payment Details
(Tick type) |
Mastercard Visa Delta Switch |
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| Credit Card Number | Name on Card | Expiry Date | Issue Number | |||
| / / / | / / / | / / / | / / / | Month/Year |
Switch only |
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Signed .............................................................. |
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| Credit Card address if different from above |
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