| CUSTOMER NAME | ||||||
| ADDRESS | ||||||
| POSTCODE | TELEPHONE NO: | |||||
| DATE OF ORDER | ||||||
| CAPE/SADDLE | GRADE | BASE COLOUR | COLOUR | QUANTITY | PRICE | TOTAL |
| (WHITE/GRIZZLE) | REQUIRED | |||||
| TOTAL | ||||||
| I ENCLOSE CHEQUE TO THE VALUE OF | ||||||
| OR | ||||||
| CREDIT CARD TYPE | CHEVRON HACKLES | |||||
| NUMBER | ||||||
| EXPIRY DATE | Brandirons Yard, Copplestone, Crediton, | |||||
| NAME & INITIAL | Devon EX17 5PD | |||||
| SIGNATURE | TEL: 01363 760090 | |||||