PHYLLIS TUCKWELL HOSPICE - NOTELETS ORDER FORM

To purchase PACKS OF NOTELETS please print and complete this form and send to:
Fundraising Dept, Phyllis Tuckwell Hospice, Waverley Lane, FARNHAM, Surrey GU9 8BL
or fax it to 01252 729414

Please send me the following number of Notelet packs:
  Packs    
Packs of Notelets £4.50 per pack of 10 £………………
 

  Postage & Packing (75p p&p per order)

 £…........0.75
 

  TOTAL ENCLOSED:

£………………

I wish to pay by  (please tick as appropriate)

Cheque

Postal Order

Mastercard

Visa

Switch

(please make cheques payable to Phyllis Tuckwell Hospice)
Card No:
Expiry Date: Switch Issue No:
FIRST NAME .............................................................................................
LAST NAME .............................................................................................
TITLE .............................................................................................
ADDRESS .............................................................................................
  .............................................................................................
POSTCODE .............................................................................................
DAYTIME TELEPHONE NO .............................................................................................
E-MAIL .............................................................................................
SIGNATURE .............................................................................................
 

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