Fax order form

To order by fax, please print out this page, complete and fax to our offices.

Please note that all deliveries are done from London (UK) and that the US Dollar price includes delivery to any destination in the world.

Our fax number in Pretoria, South Africa is + 27.12.361 0061

To return to our products page, click here, and to go to our home page, click here.

Name and surname
Credit card type Visa / MasterCard / Amex / Diners (Circle the type)
Card number  
CCV number (3 digit number on the back of your card on the signature strip)

 

Expiry date Month (............) Year (............)
E-mail address  
Telephone number  
Full street or postal address
(including State, Province and postal/ZIP code.)
line 1
line 2
line 3
Signature as on card:

.....................................

Province/State:
Postal / ZIP code:
(Postal code is also used for courier parcels, as courier companies use the code to sort their parcels)
Description

Quantity

Total

   
   
   
   
   
   
   
   
   
   
NO SHIPPING OR HANDLING CHARGES  0.00

Total US $