Mail Order Form

Type in your information then print out this page and send it to:

The Back Care Warehouse,
2a Tower Road,
Worthing,
West Sussex, BN11 1DP.

Please include either your credit card details in the spaces below, or enclose a cheque or money order payable to "The Back Care Warehouse".  
Name:             
Address line 1:  Address line 2:  
Town/City:          County:             
Post Code:         

Tel. No.or e-mail:

 

Credit Card Number (if paying by credit card):
Credit Card Type      (Visa, Master Card, etc):
Expiry Date:     Last 3 digits on signature strip:   Issue no.(if Switch): 

     
 Product Description Quantity Price(£)
Post and Packing **  
Total:

**Post and Packing
Please add the appropriate charge - these charges are shown on the 'Postage & Packing' link on the  left hand side of the main page