PRICE CLUB onLine - FAX ORDER FORM

FAX: 078-857-0500
Date: Day: Month: Year:
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Postal Code:  
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DELIVERY ADDRESS
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Address:  
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Postal Code:  
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METHOD of PAYMENT
[   ] CASH on delivery (COD)    [   ]  Bank transfer

 

ORDER ITEMS

Please use the table  below to write your order. If you do not have enough space then please use an additional print-out of this form.
Item Name Quantity Price
     
     
     
     
     
     

 

PREFERRED DELIVERY TIME

Please indicate in the space below what your preferred time for delivery is. Please note that we cannot guarantee to deliver at your specified time.
Day: Month: Time (24 hr time):