Personal Details:
Family Name: .........................................................
First Name: ........................................................
Street Address: ........................................................
Town/City ........................................................
County: ........................................................
Post Code: ............................
Country: ........................................................
Phone Numbers (incl country/area codes): ........................................................
Fax Number: ........................................................
e-mail: ........................................................
Payment Details:
Enclosed is a: cheque (UK residents only)
OR
Please debit my: Visa / Mastercard credit card OR Visa debit card OR Switch/Solo (circle one) for ŁUK.........Card Number: ........................................................
Start date: ........................................................
Expiry date: ........................................................
Issue Number (Switch/Solo): ..............................
3 digit security number: .........................
Name on Card: ........................................................
Signed by Cardholder: .................................Please print this form and scan it together with your Mail Order Form before emailing it to us at bensley@clara.net
Or send your completed forms to:Kingdom Dance Resources Limited
Sunset Hallows, 21 Admirals Close, Watchet,
Somerset, TA23 0QD, United Kingdom
or
(Tel +44 (0)01984 633735)
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