Klarit Anti Mist Treatment

Secure Order Form

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	Part 1: Your Credit Card Purchase

DESCRIPTION of order		Qty
Individual pack includes Klarit stick, cloth and instructions @	£5.00 ea.
Triple Pack of the above @	£11.00 ea.
Box of 10 Klarit Anti-mist sticks @	£32.00 ea.

TOTAL		=

Prices include post by air / first class mail and U.K VAT as applicable.
Your transaction is in (£) Sterling which is approximately U.S Dollars ...

	Part 2: Your Address details

Enter Your Name :

Enter Address Line 1 :

Enter Address Line 2 :

Enter Town or City :

County/State/Province or COUNTRY ( for non U.K ) :

Post Code / Zip Code/ Oseas Code :

Telephone Number :

Fax Number :

Your Email :

	Part 3: Your Payment


Please charge my card :	Only these cards accepted
card number :	/ / / /
card holder name :
expiry date :
start date (if applicable) :
issue number :

If you prefer to pay by cheque, please send it with order details to :

Millbride Products Ltd.
67 Fountain Road Birmingham B17 8NP United Kingdom.
Cheques to be payable to 'Millbride Products' and made out in Sterling.

Please note that goods will be despatched within 5 days of cheques clearing.

Fax: +44 (0)121 429 3231 BrianMiller@Klarit.com

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