Planet Pa Kua Products Order Form

Planet Pa Kua

Please print this order form, complete your delivery details, order requirement and mail with your cheque (made payable to 'Planet Pa Kua') or credit card details.

TO - PLANET PA KUA, 74 CHIGWELL ROAD, SOUTH WOODFORD, LONDON, E18 1NN.
PLEASE PRINT CLEARLY USING BLOCK CAPITALS

Deliver to:- Name:___________________________________________________

Address:_________________________________________________

Town: ________________County:____________Post Code: _____

Telephone No._______________ Email:___________________________
ORDER DETAILS

Product Code	Description	Price	Qty	Total
1	1	1	1	1
1	1	1	1	1
1	1	1	1	1
1	1	1	1	1
1	1	1	1	1
1	1	1	1

Total Value of Order £_______P & P(see Terms & Conditions) £_____ Total Amount Due £_______

I enclose a cheque to the value of £___________ made payable to: 'Planet Pa Kua' . OR please charge my credit card account with the total value of my order.

Cardholder's name_______________________________

Card Number _ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ Card expiry date _ _/_ _ Switch Issue No. _ _

Cardholder's signature _______________________

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