Postal/Fax Clock Box Kit Order Form

Please Complete the form and send to Range Records, 4 Botany Drive, Dudley, West Midlands.DY3 3XT. United Kingdom.

First Name..............................................................   Surname..................................................................

Mailing Address/Cardholders Address....................................................................................................
                                                                ....................................................................................................
                                                                ....................................................................................................
                                                                Postcode/Zipcode....................
Telephone Number........................................                         E-mail Address.............................................


Credit Card Details

Card Type(Please Tick):- Visa
 
MasterCard
 
Switch
 
Delta
 
American Express
 
Diners Club
 
JCB
 
Credit/Debit Card Number:-
                                       
Expiry Date(e.g. 06/02):-
       
Issue Number (Switch Card Only):-
   
Signature..........................................................

Cheque Enclosed (Please Tick):-
 

Clock Box Kit Order Details
Second Hand Colours Available:- Black, Red or Gold                                                      Minute & Hour Hand Colours:- Black or Gold

Size Kit Colour Second Hand Colour Hour & Minute Hand Colour Quantity Cost
                  
                  
                   
Subtotal:- 
 

Please add the correct postage costs per kit ordered as shown below.

Kit Size UK Europe USA/Canada Rest Of World
Large Kits 7.50 14.50 23.50 26
Small Kits 6 8.50 12.50 13.50
Total Postage Costs:-
 

If you require us to supply the CD and you have phoned us to check availability and price, please enter the details below.

Artist.............................................................   Title............................................................   Cost..............

If you wish us to fit your chosen CD please tick the box
 
Total Cost:-