Please Print This Form And Fill Out By Hand.
(You may need to adjust your printing configuration. Recommended print size. 70%)

Post This Form With Your Cheque,
PO Or Credit Card Details To:

MindZone. PO Box 161. Borehamwood.
WD6 2ZG

Or Fax Credit Card Orders only To:

Fax: 0181-905-2332

Please print clearly in BLOCK CAPITALS.�
All cheques and PO's in pounds sterling.�
Please do not send cash.
UK Orders Only.

(Please DO NOT place an order! This is not a live comercial site. It is for demonstration only.)

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Product Order Form

Product

Unit Cost

Quantity

Total Cost

Football 1

�7.99

|

�

Football 2

Coming Soon

N/A

N/A

Football 3

Coming Soon

N/A

N/A

UMA T-shirt

Coming Soon

N/A

N/A

UMA Baseball Cap

Coming Soon

N/A

N/A

Grand Total (free post and packing)

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Payment By Cheque

I enclose a cheque / PO No. ___________________for amount

�

crossed and made payable to MindZone.


Payment By Credit Card

Card Type
(please circle one)

VISA / MASTERCARD / DELTA / SWITCH

Name on Card

|

Card Number

|___|___|___|___||___|___|___|___||___|___|___|___||___|___|___|___|

Card Expires

|

Switch issue No.

|

Daytime Telephone

(code____________)

Evening Telephone

(code____________)

Cardholder Signature

|


Customer Details

First Name

|

Last Name

|

Date of Birth

DD:

MM:

YY:

Address

|

|

|

Town / City

|

County

|

Post Code

|

Email Address

|

Please tick box if you are purchasing for someone else.

Please tick box if you do not wish to receive future promotional material from MindZone or other companies.


Normal Delivery 7 to 10 days, Please allow up to 28 days.

Thank you for your order

Ultimate Mental Attitude!!!

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