Please print this form and complete the following in BLOCK LETTERS:
Name (Mr/Mrs/Ms/Miss) __________________________________________________
Address _______________________________________________________________
______________________________________________________________________
Postcode/Zip ____________________________ Country _________________________
Telephone ______________________ Email ___________________________________
EITHER
I enclose my cheque/sterling draft for __________ British pounds
Cheques/sterling drafts should be made payable to D4daisy Books Ltd
OR
Please charge my credit or debit card to the value of __________ British pounds
Card number ________________________________ Expiry date __________________
PLEASE CHECK THIS NUMBER CAREFULLY. WE ARE CHARGED IF IT IS WRONG.
Name on the card _________________________________ Security Code____________
THE LAST THREE DIGITS ON THE SIGNATURE STRIP ON THE BACK OF THE CARD.
Cardholder's signature:
____________________________ Date ___________________
Please return by post to: d4daisy books, 19 Merriefield Avenue,
Broadstone, Dorset, BH18 8DA, UK,
or by fax: If in Great Britain, 01202 897211, if outside Great Britain,
use the standard dialing code for international calls, followed by 44 1202 897211.
