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Agranova Order Form

Please refer to the Price List for current pricing.

Use this form to mail your order. For faster service, fax or e-mail :
Agranova, 34 The Drive, Orpington, Kent BR6 9AP, UK

tel: +44 1689 600 501
fax: +44 1689 897 786
 e-mail: agranova@compuserve.com

Order Date : Please write clearly - use BLOCK CAPITALS !
Title/Name :  
Company :  
Address :  
City :
  Postcode/Zip :   Country :  
Tel :
  Fax :  
e-mail :  

Code
Description            
Qty. Unit
Price
Total
         
         
         
         
Grand Total :
 

Cheque enclosed  
Bill me later  
Visa / Mastercard (see  below)  

<< Select method of payment

Mailing is free for all pre-paid orders. Shipping and handling costs will be added to the invoice for all billed and proforma orders. Payment may be made using Visa and Mastercard (see below) in US Dollars (USD) or in Pounds Sterling (GBP) or by cheque in either of these currencies:

USD cheques must be drawn on a US bank and made payable to Dr.R.J.Bryant .

GBP cheques must be drawn on a UK bank and made payable to Agranova.

  For Visa and Mastercard purchases, please fill in ALL of the details below:
Card (circle type):
Visa      |      Mastercard
Card number :  
Expiry Date :   3-digit security code :
(on the strip on the back of card)
 
Cardholder Name
as written on card
 
Card Address
house no., street
and ZIP code are required
 
Amount:
(specify currency)
Signature :