Getting Back - Order Form (Post or Fax)


invoice & delivery Address
Title:		Address Line 1*:
First Name*:		Address Line 2:
Last Name*:		City:
Phone*;		County/Region/State/ :
E-mail*;		Postcode/zip code/Area code*:
Fax;		Country*;
* denotes required field
Credit Card Details		Payment by Cheque
Card Type: Visa Master card Access Switch		I enclose a crossed cheque with my name on the back, made payable to Getting Back Ltd. (Cheque's& postal orders must be in pounds sterling)
Name on Card
Card Number:
Expiry Date: Month Year		Delivery: Credit card orders dispatched within 48 hours. Allow 10 working days for cheque orders to be dispatched.
Issue No. (Switch only)

Additional Information
How did you hear about us?		Additional Comments
Promotional offer reference
		Please print the completed form and post / fax to the address above.



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Item	Qty.	Unit Price	Total
DVD		£19.49
Video		£16.49
Book		N/A
Book & DVD		N/A
Book & Video		N/A
For UK deliveries postage and packing is included		Sub Total £
sub total £	For deliveries outside the UK please add: EU £1.00 Outside EU: £2.50	£	Total £