- Please complete and print this form. Post with your cheque or fill in your card details below.

HEXHAM SEALANTS & COATINGS: DIY PACK ORDER FORM
(NEW PRICES FROM 1ST SEPTEMBER 2005)

First name
Last name
Street address
City/Town
County
Post Code
Phone *
E-mail *
    * One or both required

ORDER FORM

No:      Kennelseal-2 - 7.5 litre@ £  = £    click on each
No:      Farmseal - 7.5 ltr          @ £  = £    "CALC." button
No:     'Dry-it-Out' - 7.5 ltr          @ £  = £    even if not
No:      Sure Shot sprayers      @ £  = £    ordering item
No:      Compressor for above @ £  = £   
No:      Cleaning solvent - 3 ltr @ £  = £   
No:      Carriage                         @ £  = £   
                                                      = £   
                                                      = £   
                                                      = £   

Hexham Sealants & Coatings Station Yard
Station Road
Corbridge
NE45 5AZ

Tel: 01434 633344

Make cheques payable to

"Hexham Sealants & Coatings"

We accept payment with the following debit/credit cards - Visa, Visa debit, Mastercard, Switch/Maestro, Delta, JCB, Eurocard, Solo

If paying by card, complete details below and press submit. Debit card payments are free -
credit cards are surcharged at 4.5%

name on card
address          (if different from above)
Phone                E-mail 
card no.        

Card type          Valid from month year    Expiry month exp year

   Security code (this is the last 3 digits on the signature strip)      Issue number