ORDER FORM

Please state below the items you would like to order, together with your preferred method of payment NO DETAILS UNIT PRICE () TOTAL AMOUNT ()

FOSFA Member

Yes

No

Method of Payment (please tick the relevant box) Bank Transfer Bank: Cheque The Royal Bank of Scotland Plc 5-10 Great Tower Street London, EC3P 3HX, UK 20849471 15-20-25 RBOSGB2L GB57 RBOS 152025 20849471 Credit Card

Account No: Sort Code: Swift/BIC Code: IBAN No:

Credit Card Payments Payments over the sum of 750 will incur a 10 administation fee. Please provide the issue number of the card for Maestro, Switch, Solo and JCB. The Federation can accept the following credit cards Visa Company: Address: Postcode: E-mail: Tel No: Name on Card: Card No: Issue No: Amount: Valid From: Expiry Date: Account: Security No:
(Last 3 digits on reverse of card)

MasterCard

Visa Electron

Maestro

JCB

Switch

Solo

Date:

Invoice:
April 2010

Please Fax Back to: +44 207 623 1310