Please (1) Print this form. (2) Use a pen to fill the form - PRINT CLEAR CAPITALS. (3) Fax the form. Thank you.
BARCODE.CO.UK
JIT (UK) LTD, 5 LONGHEY RD, MANCHESTER, M22 8UA, UNITED KINGDOM
Tel: 0870 741 2839 Fax: 0870 741 2840 Email: helpbarcode.co.uk

FAX: 0870 741 2840

 
ORDER NUMBER: DATE:

SHIP TO ADDRESS:

CONTACT: COMPANY:
ADDRESS:
ADDRESS:
CITY: POSTCODE:
TEL: FAX:
EMAIL: FOR EMAIL DELIVERY:  [  ] YES   [  ] NO
JIT CODE / MANUFACTURERS PART NO. / DESCRIPTION PRICE QTY SUB-TOTAL
       
       
       
       
       
       
       
       

(8.50 next day) SHIPPING  

 

VAT (17.5%) 

 

TOTAL 

 
CREDIT CARD NUMBER:  [  ] VISA  [  ] MASTERCARD  [  ] ACCESS  [  ] SWITCH  [  ] AMERICAN EXPRESS
                                                 

EXPIRY DATE:

EXAMPLE:

    /        
0 6 / 2 0 0 1

LAST 3 (OR 4) DIGITS OF SECURITY CODE: Printed on the back of your card / usually printed on the signature strip

       

SWITCH ISSUE NUMBER:

           

CARD HOLDER'S NAME:

CARD HOLDER'S SIGNATURE: