PHAZE ONLINE ORDER FORM   

To print this form click 'File', 'Print'.
Please read the important information on the phaze site about ordering before filling in this order form.

CODE DESCRIPTION COLOUR SIZE QUANTITY PRICE
           
           
           
           
           
           
           
           
           
           
           
           
           
           
GRAND TOTAL
GOODS TOTAL
  
POSTAGE
  
FORENAMES.................................................................    SURNAME.............................................................

ADDRESS..............................................................................................................................................................

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

POSTCODE..........................  COUNTRY........................................    TELEPHONE.....................................

visa.jpg (6504 bytes)I WISH TO PAY BY ACCESS/VISA

CARD No. ........................................................... EXPIRY DATE..................................................

Name/Address of card holder if different from above........................................................................................

For Official Use Only

 

AD. CODE

 

REF No.

 

CH/P.O./VIS

 

DATE RECEIVED

 

DATE COMPLETED