DETOUR RECORDS MAIL ORDER & DISTRIBUTION COMPANY ORDER FORM
| CUSTOMER NAME | |||
| CUSTOMER ADDRESS | |||
| POST CODE | |||
| COUNTRY | |||
| PHONE NUMBER | |||
IS THIS YOUR FIRST ORDER YES / NO IF NO WHAT IS YOUR ACCOUNT NAME[______________________]
r Please Reserve Me The Following Items (send no money)
r Please send me the following items (enclose full payment) rI AM PAYING FOR ORDER REFERENCE _____________________
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Quantity |
Artist |
Title |
Grade |
Format |
Price £ |
p |
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SUB TOTAL |
£ |
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Post and Packing Country______________________________________________ |
£ |
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Recorded Delivery (UK only) + 68p OR Insurance (Worldwide) +£3.50 |
£ |
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Less Any Credit Due (Ref: ___________________________________) |
- |
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TOTAL Payment Enclosed r Payment to follow on confirmation of reserve items r |
£ |
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Payment Method |
Cheque r |
Postal Orders r |
Credit Note r |
Credit/Debit Card r |
Credit Card Info: Credit Card r or Debit Card r OR Card info on file r Please sign only
| CARD TYPE | ||||||
| CARD NUMBER | ||||||
| EXPIRY DATE | VALID FROM | |||||
| CARD HOLDERS NAME | ||||||
| CARD HOLDERS NAME/ADDRESS AND PHONE NUMBER IF DIFFERENT | ||||||
| SECURITY CODE | [ ] [ ] [ ] back of card on signature strip SWITCH ISSUE NUMBER [ ] | |||||