JEREMY ATKINSON - MASTER CLOG MAKER
PRINTABLE ORDER FORM
| Your Name | ................................................................................................................. |
| Address | ................................................................................................................. |
| ................................................................................................................. |
| Post Code/Zip | ............................................ | Country | ............................................ |
| Telephone | ............................................ | Fax | ............................................ |
| ......................................................................................................................... |
| I would like to order | ORDER VALUE £ | |
|---|---|---|
| 1. | Type of Clog ................................................... | ................................... |
| 2. | with the following extras | |
| ............................................................................. | ||
| ............................................................................. | ||
| ............................................................................. | ................................... | |
| Value of Order Excluding Postage | ................................... | |
| Postage | ................................... | |
| TOTAL ORDER VALUE | ................................... |
Jeremy Atkinson, 44 Duke Street, Kington, |