You can use this form to place an order if you already have a credit account with us, or if you would like to pay by credit card. New customers who wish to set up a credit account can apply using the account application form. Fields marked with * are required fields. Data Protection Statement
1). Your company details:
Your name:	*
Tel:	*
Company:
Delivery Address:	*
Town/City:	*
Post Code:
2). Payment by:
Credit account:   OKW account No.
Visa Card:   Mastercard: Card number: Expires:
Card Holder Name:	*
Address:	*
Town/City:	*
Post Code:	*
Card Holder signature ___________________________________
3). Order Details:
Your order number:
OKW Quotation No.	(if known)
OKW Description Qty Price Delivery Part No.     quoted date
4). Your special Instructions (if required):
Please print this form and fax it to us on 01489 583836