Large Order Discounts: 60 to Less Than 100 - 10% Off 100 Upwards - 15% Off

ORDER FORM - AQUATICS

How to Order

BY POST - Send your completed order form with payment to Viresco (UK) Ltd, 50A Market Place, Thirsk, Nth Yorks, YO7 1LH. BY PHONE - 01845 525585 Weekdays 8am – 6pm Weekends 9am – 5pm BY FAX - 01845 523133 ONLINE - www.viresco-uk.com Easy to use, secure online ordering 24 hours a day DELIVERY - Delivery is included in the price of order. We will endeavour to fulfil your order within 5 days of receipt. If you wish to collect direct from our offices in Thirsk, please telephone in advance to make arrangements.

Ordered by: Delivery address if different from that on left:

Mr/Mrs/Other ______Mr/Mrs/Other ______

Address ______Address ______

______

Post Code ______Post Code ______

Telephone No. (inc. dialling code) ______

Email address (By giving us this, we will send you updates and offers from Viresco (UK) Ltd. We will not use your name for any other purposes and we will not pass your email address to any third parties.) ______

PLEASE SEND ORDER TO: Viresco (UK) Ltd, 50A Market Place, Thirsk, North Yorkshire, YO7 1LH.

Large Order Discounts: £60 to less than £100 - 10% off £100 upwards - 15% off

Price per Number Value Product Name Pack Code Pack Size Pack (inc VAT) required £ p VAQG/01 £23.7 Viresco Aqua (Example only) 10g 1 23 75 0 5

Total Less Large Order Discount TOTAL DUE

Method of Payment We would be pleased to send our catalogue to I enclose a cheque/postal order for £______payable to Viresco (UK) Ltd one of your pond-keeping friends. If you would like us to do so, please give their name and OR please debit my account: address below: Mastercard Visa Maestro Mr/Mrs/Other

Address:

Card Valid From Card Expiry Date

Issue No: Security Number (Maestro cards only) (last three numbers on reverse of card)

Postcode

Signature: ______

Viresco (UK) Ltd will use the information you have provided above to deal with your orders and for our own administration and marketing purposes. We may use this information to let you know about other products which may be of interest, but we will not pass your details to any third parties. Viresco (UK) Limited is a company registered in England and Wales with company number 5079726 VAT No: 481 9223 35 2008