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CUSTOMER INFORMATION<br />
Date of Order: Your Order Number: ROMPA ® Account no:<br />
CUSTOMER INVOICE ADDRESS DELIVERY ADDRESS (if different)<br />
Contact<br />
Establishment<br />
Address<br />
Post code<br />
Tel<br />
Fax<br />
Contact<br />
Establishment<br />
Address<br />
Post code<br />
ORDERING INFORMATION - Please use lined paper for extra orders<br />
CODE NAME OF ITEM - DESCRIPTION COLOUR/FABRIC PRICE QTY TOTAL £<br />
EASY WAYS TO PAY- please tick as appropriate<br />
(By Telephone: CREDIT, DEBIT CARDS ONLY)<br />
PLEASE DEBIT MY CARD: AM-EX<br />
MASTERCARD<br />
MAESTRO<br />
Cardholders Name<br />
Cardholders Address<br />
CHEQUE<br />
ROMPA<br />
ACCOUNT<br />
VISA VISA DEBIT<br />
I enclose a cheque / postal order<br />
(made payable to ROMPA Ltd ® ) for £<br />
Please invoice my account A/C no:<br />
ORDER FORM<br />
Thank You for ordering from ROMPA ®<br />
ORDER BY PHONE 0845 230 1177 ORDER BY FAX 01246 221802 ORDER ONLINE WWW.ROMPA.COM<br />
Tel<br />
Fax<br />
Please use block letters when ordering!<br />
12345 <strong>Rompa</strong> Product Name Red £50.00 2 £100.00<br />
Card Number:<br />
Cardholders Signature<br />
Date<br />
Print Name<br />
Card Start Date: Card Expiry Date:<br />
For your security we will call you to verify your credit card details.<br />
Issue No<br />
(Maestro Users Only)<br />
FREIGHT POLICY /<br />
CARRIAGE CHARGES<br />
All orders will attract a charge of £7.95 + VAT as a<br />
contribution towards packaging and carriage costs.<br />
Charges for deliveries to non-mainland UK destinations<br />
will reflect the actual cost involved - please contact<br />
ROMPA ® Customer Sales on 01246 211777 for details.<br />
Goods TOTAL<br />
+HANDLING<br />
CARRIAGE CHARGES<br />
Sub TOTAL<br />
+VAT<br />
TOTAL £
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