Billing Address:

Name:

Address


city/town

county:

Postcode:

country:

Tel:

email:

Date:

Delivery Address: (if different)

Name:

Address


city/town

county:

Postcode:

country:

Tel:

email:

Date:

Card Type:   Visa   Mastercard   Delta   Switch   Solo

Name on card:

card number:

Valid from date:
 mm yy
Expiry date:
 mm yy

3 digit verification number on back of card
 
issue number: if your card has one
 

Quantity Required:
  1 Litre Perfect Aloe £17.95 + £4.99 delivery = £22-94
  6 x 1 Litre Perfect Aloe (call for or email delivery prices)
  2 Litre Perfect Aloe £32.95 + £7.00 delivery = £39-95
  6 x 2 Litre Perfect Aloe (call for or email delivery prices)

ORDER BY CHEQUE / POSTAL ORDER
Please make your cheque or postal order payable to: DSM Management
And then send the payment and this order form to:
DSM Management, 2 Maker Close, Reading, Berkshire, RG30 3QL

Goods will be dispatched on cheque clearance.

Thank you for your order.