Order Form

Please print the form below and send

Because of the unique nature of our business and most items being one-off, please submit your order by any method, we will then confirm the item is still available, ask if you wish to proceed and arrange payment.

Personal Details
Full Name:
Address:
Postcode:		Telephone Number:
E-mail Address:
Order Details
Stock No: Short Description Price Qty Total   Postage/Shipping is extra unless specified, please enquire for a quote. Final Total:
Only fill in the details below if you are printing the order form off to fax or post to us.
Credit Card Details
Card Type:		Expiry Date:
Name on Card:		Security Code: (last 3 digits printed on rear of card)
Card No:		Issue No: (Switch only)

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We accept no responsibility for credit card details that are e-mailed to us. We do not have a secure server.

L A Services Ltd, Bramcote Fields Farm, Bramcote, Warwickshire Tel: 01455 220340
The Engineers Emporium is a registered trademark of LA Services Ltd © 1999 E & O.E