Continence Foundation Professionals Order Form

The Continence Foundation
PUBLICATIONS FOR PROFESSIONALS ORDER FORM

Please print out this page and send it to us with your payment.
We are sorry but at this point we cannot offer secure payment over the net.

Either fax this form to 020 7404 6876 if you pay by credit card or else post it with your payment to:

Orders, The Continence Foundation. 307 Hatton Square. 16 Baldwins Gardens. London EC1N 7RJ

NOTHING SUPPLIED WITHOUT ADVANCE PAYMENT. PLEASE ALLOW 28 DAYS FOR DELIVERY.

DELIVERY DETAILS:

Name: ..........................................................................................................................

Organisation: ...............................................................................................................

Address for delivery: .....................................................................................................

................................................................................................Postcode: ......................

Tel no. (optional: in case of queries): ...........................................................................

CREDIT CARD PAYMENTS:

Credit card number: .....................................................................................................

Expiry date: ............... / ........................ Name on card: .................................................

Please add your card billing address and postcode if they are different from the delivery address.

.................................................................................................................................

ITEMS REQUIRED:

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