ORDER FORM Fill out and print form Title: Mr Mrs Ms Dr Rev Name: Address: Post Code: Telephone: Catalogue No: Description: Colour: Wall Fixing/Stake/Free Standing: (Please select where appropriate) Wall Fixing Stake Free Standing Text Colour: Gold Black White Symbol: Sitting Cat Sleeping Cat Horse Head Sitting Rabbit Begging Rabbit Paw Print Butterfly Horseshoe Scroll Star Inscription:    PLEASE PRINT CLEARLY ON REVERSE Item Price: Post & Packing:(Select "NIL" for items to be collected) £12.50 NIL Total: CHEQUE P/O or CREDIT CARD Card Number: Issue Number: (Switch) Valid From: Expiry Date: Security Code: (Last 3 Digits on Signature Strip on back of card) Signature: (Leave this field blank to sign when printed out) Please make cheques payable and forward to: Nationwide Pet Memorials, Meeres Lane, Kirton, Boston, Lincolnshire, PE20 1PR Please allow 6 weeks for delivery of Memorials Fill out and Print Form | Close Window