Phillips & Wood Fine Art Ltd
104 Lower Marsh, Waterloo. London. SE1 7AB.
Tel 020 7928 4 928 Fax(+44) 020 7928 9668
Email sales@phillipsandwood.com
www.phillipsandwood.com

As We are currently unable to offer you secure credit card transactions via the Internet
Please PRINT this page, complete the form and Fax or mail to above address

Name
Address

Telephone
Fax
E-Mail

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Please tick if Print Order Please tick ifFramed Picture Order
Please Supply the Following Items Price

Print Title                                                                               Artist
1._______________________________________________________________
2._______________________________________________________________
3._______________________________________________________________
4._______________________________________________________________

£

Frame Style Number and Mount colour
1.___________________________________________________________
2.___________________________________________________________
3.___________________________________________________________
4.___________________________________________________________

£

Delivery Method______________________________________________

£
Delivery Address
if Different from Above

TOTAL
£

I Enclose a Stirling Cheque / Money Order to the value of

£

Please Debit My Account

SIGNED__________________________
(please tick card type)
VISA
MASTER CARD
SWITCH
DELTA
AMEX

Registered in Cardiff
Company Number 331 0354

 Card No._________________________
Expires Date_______________________
If Switch, Issue Number______________
Name on Card_____________________
Card Billing Address________________
________________________________
________________________________

Amount In Words_______________________

Amount in Figures £_____________________