Manna House Bookshop Online Order
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I would like to order the following:

Title: _________________________________________________

Author/Artist:__________________________________________

Price: _________ Quantity: ____   Total to pay:_________

Date: ___________________

Your phone number (in case of queries:)__________________

Card no: ______ / ______ / ______ / ______

Type (Visa/MasterCard/Amex etc): _______________________

Name as it appears on the card: _________________________

Full address including postcode: ________________________

_________________________________________________________

_________________________________Post Code: ______________


Valid from date: ___ / ___

Expiry date: ___ / ___

Issue No. (for Switch cards): __________

Please debit my account with £____:___

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When complete, fax this form to Manna House Bookshop on 01604 635498