<

Specialist Piercing Jewellery Order Form

Please complete this form if you wish to order from Specialist Piercing, print the form and send with Cheque or Postal Order made out to 'Specialist Piercing' :-

Secialist   Piercing
Body Piercing Centre
292 Holbrook Lane
Coventry
CV6 4DH

Please provide the following contact information:

First Name(Req'd) 
Last Name (Req'd)
Street Address (Req'd)
Address (cont.)
City (Req'd)
County / Area
Postal Code (Req'd)
Home Phone (Req'd)
E-mail (Req'd)
Material Description Gauge
mm		 Int.
Dimn.
mm		 Ball
Size
mm		 Jewel
Colour		 Qty Total
Price
(2Dec.)
Comment (75 Chars maximum)
Comment (75 Chars maximum)
Comment (75 Chars maximum)
Comment (75 Chars maximum)
 
Post and Packing Upto 10 items £1.95 
 
Total Price

Please make Cheques or Postal Orders payable to 'Specialist Piercing'
If you are unsure of pricing either telephone (024) 7626 5349 or submit this form and we will get back to you ASAP.  

Created by Saxton IT Services
Copyright © 1999 [Specialist Piercing]. All rights reserved.
Revised: March 26, 2005

Site Map