Bluebell Data Fax and Mail order Page

BLUEBELL DATA MAIL/FAX ORDER FORM

Print & Mail to:

Bluebell Data
PO BOX 1174
Swindon
SN2 1XE

Or Phone: ++44 (0)1793 633316 (Sales Only)
Please make cheques payable to Bluebell Data

I am paying by [ ]Check [ ]Money Order [ ]Credit Card (Also fill out fields below)

Name ________________________________________________

Address_______________________________________________

City_____________________

County / State_________Postal Code / Zip_____________

Country_____________________

Phone Number _________________________________

Email Address__________________________________________

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Please feel free to fill it out yourself.

Product:______________________________________________

Sub Total:______________________________________________

Credit Card Order [ ] VISA [ ]MasterCard [ ]Switch (Your Statement will show 'Bluebell Data')

Name on Card________________________________________________

Credit Card No. _________________________________Exp Date __________

Valid From Date__________

Issue Number (switch): __________________

Carriage________ £1.00 UK Free order over £50.00 £5.00 Rest of the world

Charge this Amount: __________________

Signature ______________________________________________________

A note to our overseas customer Cheques must be drawn on a UK bank in sterling, see your bank for details.