Payment by Cheques & Postal Orders

Please complete and print out the order form below and post it together with a cheque or postal order for the full amount to: Euromedical Group, Mid Kent Shopping Centre Castle Road, Allington, Maidstone, Kent ME1 0PU

Payment by Credit Card

Please complete and submit the order form below. In the interest of customer security Euromedical will then contact you for your credit card details.

Customer details

Tick if you do not wish to receive information from other mailing companies

Name

Address

Address

Postcode

Daytime Tel

Evening Tel

Fax

Email

Qty

Description and Product code

Size

Colour

Price each

Total goods

Total Goods

Method of payment
I wish to pay by (Please tick box)

P&P

?5.95

Total to pay

Cheque Postal order Credit card

Card Type: Switch VISA Mastercard

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________________________________________ Signed ______________________ Date __________

Declaration for relief from VAT
I am chronically sick or disabled (as defined below) and I am receiving from Euro Medical the goods on this order form, which are for my personal or domestic use. I claim that the supply of these goods is eligible for relief from VAT under the VAT Act 1994.
?
Insert details of your chronic sickness or disability below. Note: It is an offence to make a false declaration
?
________________________________________ Signed ______________________ Date __________