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