Please print out, complete, and send with your order to pay by credit card.   We regret that at the present time we are unable to accept credit card payments directly online.

Name:
Address:
Date:	Postcode:	Tel:
E-Mail Address:
Please take Payment for the following ( Please indicate as appropriate )

Tick Here	Description of Service		Cost : £.p.
[___]	Book Publications as detailed on attached list.		£
[___]	CD & Microfiche Publications as detailed on attached list.		£
Total Value of Payment : £		In Words :

I WISH TO PAY BY -          VISA    /    MASTERCARD
My Card  Number is:	[ __ : __ : __ : __ ] - [ __ : __ : __ : __ ] - [ __ : __ : __ : __ ] - [ __ : __ : __ : __ ]

Name on Card :  (BLOCK CAPITALS)		Expiry Date :
Signed :		Date :

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