www.Boots-Boots.co.uk
ORDER FORM
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Cardholders Details
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Delivery Address if different
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Mr/Mrs/Miss/Ms........................................................ .
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Mr/Mrs/Miss/Ms..............................................
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Address...........................................................
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Address.........................................................................
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Town/City......................................................
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Postcode...........................................................
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Town/City..................................................................... .
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Yes, please send me special offers & discount
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Postcode........................................................................
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vouchers
by email: by post: ...................
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Telephone number......................................................
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(Please tick the one that you would prefer)
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Email Address...........................................................
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N.B. we will not share your details with any other companies
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ORDER DETAILS
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ORDER CODE
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PRODUCT DESCRIPTION
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QTY
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PRICE
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TOTAL
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£
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£
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£
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£
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£
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£
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£
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£
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£
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£
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£
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£
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£
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£
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Postage
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£
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Total
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£
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PAYMENT DETAILS
I wish to pay by (please circle)
OR by cheque/postal order (Payable to: Boots Boots)
Name of issuing bank/building society:
Card Number:______________________________ Start Date:_________________ Expiry Date:_________
Switch issue no:_____________________________________ 3 digit security code:_______
(last 3 digits on signature strip)
Signature:________________________________________________ (I am over 18)
Please Post To: Boots Boots, 3 Brunswick Road, Cannock, Staffordshire, WS11 5SF