ORDER FORM for Cheque Payments

Please complete this order form, print it out, and attach your cheque made out to ‘SafetyPocket’ Supply Co.

MOST IMPORTANT: We can only accept cheques with the bank guarantee card
(this is the same as your debit card) number written on the back.

Please then post the order form and your cheque to:

SafetyPocket Supply Co.

6 Harborough Green

Apperley Bridge

Bradford

BD10 0UD

FROM: (BLOCK CAPITALS PLEASE)

Name:
Address:
Postcode	Telephone:
Email:	Email: (repeat):

PLEASE SUPPLY:

Quantity	Description	Price Each	Total	Total Cost
	SafetyPocket	£ 1.00	£	:
Postage and Packing total 50p				: 50p
TOTAL to pay:				£ :

Thank you for your order