Order & Credit Card Details Form

Fill in the details of your order. You can pay in any of the methods shown on the PAYMENT DETAILS page.

Please note this is not a secure page.
So if you wish to order and pay by credit card fill in only part of your credit card details in the boxes provided near the bottom of this page. I will confirm if the item is still available. You can then send the remainder of your details by email or fax.

Very Important !!! You must fill in your e-mail address to get a reply, otherwise I cannot contact you.
You are using my e-mail system not your own. You are putting your details directly into my server mail box.

Please complete the form below for both Worldmedals & Antique & Collector

Your Details:
Name:
Shipping Address: Don't forget the post code:
Tel no:
Fax no:
Important >>>>	You must fill in your contact Email address :-
Contact e-mail Address:
Re Enter Contact e-mail Address:
Ebay user Name if any:
	Order can only be processed if you fill in your Email address:-
Item Order Form	Important !! Please put a full description of the item you wish to order. i.e. Miniature or Full-size or Medal Number which ever is appropriate
To pay by Credit Card you must fill in all the blanks below
Authorisation: I	authorise you to debit the credit card detailed below with a cost agreed by me.
Put partial credit card details in the blank spaces	.
	/ Expiry Date : Issue number: For Switch and Maestro Last three digits on the signature strip: Without this the card can not be processed
	Send the last block numbers ( # # # # ) by Email
	Name on the Card : It is important to give the exact name as it is on the card
	Your Card Billing Address
From: 1st January 2005 to comply with Pin & Chip requirements this section must be completed for Address verification  otherwise we may not be able to send the order >>>>>>>>>>>>
Do not forget your e-mail address
Press send once and your details will be sent. Please ignore the following message. Your details will have been sent.