ORDER FORM
TEL: 0845 450 5950 / 01453 752216
Date __________________________________________________
Delivery address if different
Mr/Mrs/Miss/Ms _______________________________________
Mr/Mrs/Miss/Ms __________________________________________
________________________________________________________
___________________________________________________________
________________________ Postcode ____________________
_________________________ Postcode _______________________
Daytime telephone _____________________________________
Daytime telephone ____ ____ _______________________________
E-mail _________________________________________________
E-mail ____________________________________________________
Please read our Main Terms and Conditions on the facing page. If you would like help working out your order, please do not hesitate to phone for assistance.
Website: www.healthy-house.co.uk E-mail: info@healthy-house.co.uk
The Healthy House Ltd, The Old Co-op, Lower St., Ruscombe Stroud, Glos, GL6 6BU
Code Description of goods Quantity Size Unit Price Total __________________________________________________________________________________________________________
__________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Sub-total VAT Exemption All goods include VAT unless they have been zero rated by Customs and Excise. If this is the case the VAT free price will be stated alongside the product. If you are purchasing any of these items for your own use, and you suffer from either S.A.D. or dust mite allergy, please complete this form and return it with your order. Please do not deduct VAT from any other prices as this may delay your order and VAT will have to be paid. Declaration for S.A.D. and dust mite allergy I (name below) declare that I am suffering by reason of: 1. Seasonal Affective Disorder and that the Light Box that is being supplied to me by The Healthy House Ltd is for my domestic or personal use. 2. Asthma, eczema, rhinitis or dust mite allergy and that The Healthy House Cotton or The Healthy House Microfibre Polyester dust mite cases that are being supplied to me by The Healthy House Ltd are for my domestic or personal use.
P/p Please add
ÂŁ4.50
DD (if applicable) Please add Direct Delivery or Special Delivery Priority - Next working day, please add additional
ÂŁ2.50
Total Method of payment: Cheque ____ Credit Card ____ Debit/Switch ____ Card Number MasterCard/Visa?Maestro/Switch/Solo
I claim relief from value added tax under Group 12 Schedule 8 of the Value Added Tax Act 1994.
Valid From
Signature _____________________________ Date ______________________________
Issue no. (Switch only)
Full name (Dr, Mr, Mrs, Ms, Miss) ______________________________________________
Name on the card ___________________________________________
Address ___________________________________________________________________
Expiry Date
Security no
Signature __________________________________________________
___________________________________________________________________________
Address of card holder (as seen on statement) if not as above Post code __________________________ Tel: __________________________________
____________________________________________________________ Goods ordered _____________________________________________________________
___________________________________________________________ If you would prefer no more mailings from The Healthy House Ltd please tick here
THANK YOU FOR YOUR ORDER
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