Breweriana: Order form

To place an order, please read our standard terms and conditions, then print out the following form and fill in as required:

Name: _________________________________
   
Address: _________________________________
_________________________________
_________________________________
City: _________________________________
Region: _________________________________
Postcode: _________________________________
Country: _________________________________
   
Tel (including code): _______________________
Fax (including code): _______________________
e-mail: _______________________
   
Items required: _________________________________
(please see our catalogue for full range) _________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
   
Total price (including postage): £ ________
   
Method of payment:
(please tick as appropriate)		 UK sterling cheque

Credit card
   

Cheques should be made payable to "Beery Bits and Bobs" and sent with this completed form to the address given at the foot of this page.

If you are paying by credit card, please fill in the following credit card details:

Cardholder's name and initials:
(As shown on card)		 _________________________________
   
Cardholder's full address:
(If different to address given above)		 _________________________________
   
Card type:
(i.e. Visa, Mastercard, Visa Delta)		 _________________________________
   
Card issuer:
(e.g. Citibank, NatWest etc)		 _________________________________
   
Card Number (please add security code to finish): _________________________________
   
Card Expiry Date _________________________________
   
Please charge my credit card with the sum of GB£:
(amount in words)		 _________________________________
   
Please charge my credit card with the sum of GB£:
(amount in figures)		 _________________
   
Signature: __________________
   
Date: _____________

When you have completed this form, please return it by post (with your cheque, if not paying by credit card) to:

Malcolm Kay
Beery Bits & Bobs
7 Lyndon Close
Castle Bromwich
Birmingham
B36 0AJ
Great Britain

[IMPORTANT: Please note that for security reasons credit card information should not be sent by regular e-mail.]

For further information, please contact Beery Bits & Bobs at our usual coordinates.

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