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Agranova Order Form

Please refer to the Price List for current pricing.

Use this form to send your order by fax or e-mail :
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 :  

Qty. Unit
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 to be made using Mastercard or Visa (see below) in Pounds Sterling (GBP) or by cheque.

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
(specify currency)
Signature :