Pureflo logoPureflo Direct - Printable Order Form

As an alternative to the online ordering facility, please print and then complete this form and send with payment to:

Pureflo Direct Ltd.
50 St Leonards Road, Bexhill on sea, East Sussex, TN40 1JB

Or please fax the completed order form to 01424 730291
Product
Quantity
Cost
     
     
     
Postage and Packing   £2.50
Total Cost:
  
(If you are outside of UK, orders over £25 have a postage cost of £5.00)
 
Name .......................................................................
Address .......................................................................
  .......................................................................
  .......................................................................
Postcode .......................................................................
Telephone .......................................................................
 

Method of payment: Cheque ( ) Postal Order ( ) Credit Card ( )
Please make cheques payable to Pureflo Direct Ltd.

If paying by credit card please complete:
Type of card: Visa ( ) Master Card ( ) Switch ()
Name on card:.............................................................................
Card Number...................../................../.................../..................
Start Date........................................................................(mm/yy)
Expiry Date......................................................................(mm/yy)
Issue Number (Switch Only)........................................................
Security Number..........................................................................
(the last three numbers printed on the signature strip of your card - NOT your pin number!)

Pureflo Points:
Enter your Pureflo Points ID: ......................................
[   ] If you don't have an ID and would like to join.

Thank you for your order.