Mia Wood - Mail Order Form

Please print out and send the completed form to:

Mia Wood Ltd
9 Station Parade
Kew Garden Village
Richmond
Surrey TW9 3PS

Tel. +44(0)20 8439 9265
Fax. +44(0)20 8439 9275

Product
Code e.g. WR21

Description

Quantity

Item Price

Total

Please make cheques payable to Mia Wood Ltd and ensure that you write your name and address on the reverse

Total Goods

Please tick
below

Card Type

Standard P+ P

under £80.00

£4.95

Mastercard

Free Postage

over
£80.00

FREE

Visa

Grand Total

Maestro, Switch, Delta, Connect

Heavy Items Please add £10.00 per item

valid from

expiry date

Card number

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Signature

Card Holder's Name
( in block capitals )

Card Holder's
Address

Please print out and send the completed form to: Mia Wood Ltd 9 Station Parade Kew Garden Village Richmond Surrey TW9 3PS					Contact Us Tel. +44(0)20 8439 9265 Fax. +44(0)20 8439 9275
Product Code e.g. WR21	Description				Quantity	Item Price	Total










Please make cheques payable to Mia Wood Ltd and ensure that you write your name and address on the reverse					Total Goods
Please tick below	Card Type				Standard P+ P	under £80.00	£4.95
	Mastercard				Free Postage	over £80.00	FREE
	Visa				Grand Total
	Maestro, Switch, Delta, Connect				Heavy Items Please add £10.00 per item
	valid from	/	expiry date	/
Card number	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature
Card Holder's Name ( in block capitals )
Card Holder's Address