Order Form      

Home Contents Order Form

Please fill in the form below and then print it off using the "print" button in your browser.

You can then send it to:

                    Mick Bassett

                    (Canal Specials)

                    17 Falcon Close

                    Broughton Astley

                    Leicestershire

                    LE9  6RT 

Or simply Telephone: (+44) 01455 284493             

QTY

DESCRIPTION & SIZES

Please add 3 for postage and Handling (UK Only)

I enclose a cheque / PO for made payable to:  Mick Bassett

Please provide the following contact information:

Surname

First Name

Address

Town

County

postcode

Telephone No.

FAX

E-mail