Personal Details:

Family Name:         .........................................................
First Name:             ........................................................
Street Address:       ........................................................
Town/City   ........................................................
County:                      ........................................................
Post Code:        ............................
Country:                  ........................................................
Phone Numbers (incl country/area codes):    ........................................................
Fax Number:         ........................................................
e-mail:                  ........................................................
 

Payment Details:

Enclosed is a: cheque (UK residents only)
OR
Please debit my:   Visa / Mastercard credit card  OR  Visa debit card OR Switch/Solo (circle one)         for £UK.........

Card Number:        ........................................................
Start date:           ........................................................
Expiry date:           ........................................................
Issue Number (Switch/Solo):           ..............................
3 digit security number:           .........................
Name on Card:      ........................................................
Signed by Cardholder:                 .................................

Please print this form and FAX it together with your Mail Order Form on:-

+44 (0)01984 632645

Please e-mail us to confirm your fax has been sent.

Or send your completed forms to:

Kingdom Dance Resources Limited
Sunset Gate, St. Audries, Taunton,
Somerset, TA4 4EA, United Kingdom  

or

(Tel +44 (0)01984 633735)