Please fill in this form, print it, then send it via fax or post.
First Name
Last Name
Cardholder Billing Address:
Address:
Town / City:
County / State:
Postcode / Zip code:
Country:
Delivery Address:
If you would like us to deliver the watch(es) to an address other than the cardholders address,
please telephone us to discuss.
Details:
Phone:
Fax:
E-mail:
Credit Card Information:
Visa
Mastercard
Switch
American Express
Name on Card:
Card Number:
Exp. Date:
Month (MM)
Year (YYYY)
Watches:
Reference
Options
Price
Qty
Subtotal
1
2
3
4
5
* Country:
UK
EU
RoW
* VAT:
17.5%
17.5%
0%
* Delivery Charge:
£4
£6
£12
* Engraving messaging (if required £20 /watch):
Inscription (3 initials max):
TOTAL
VAT*
Delivery*
Engraving*
GRAND TOTAL
Verity Time Company Limited
P.O. Box 188, Tring, Hertfordshire, HP23 6YU
Tel: +44 (0)1442 828585 Fax: +44 (0)1442 826945 Email:
info@veritytime.co.uk
