The Continence Foundation
PUBLICATIONS ORDER FORM

Please print out this page and send it to us with your payment.
We are sorry but at this point we cannot offer secure payment over the net.
Either fax this form to 020 7404 6876 if you pay by credit card or else post it with your payment to:
Orders, Continence Foundation. 307 Hatton Square. 16 Baldwins Gardens. London EC1N 7RJ
NOTHING SUPPLIED WITHOUT ADVANCE PAYMENT.  PLEASE ALLOW 28 DAYS FOR DELIVERY

DELIVERY DETAILS:

Name ...................................................................................................................................

Address for delivery ...............................................................................................................

................................................................................................Postcode ..............................

Tel No. (optional: in case of queries) .........................................................................................

CREDIT CARD PAYMENTS:

Credit card number ................................................................................................................

Expiry date ............... / ........................ Name on card ...........................................................

Please add your card billing address and postcode if they are different from the delivery address.

..........................................................................................................................................

If you are paying a Friends subscription opr making a donation and pay Income tax we can reclaim tax on these amounts. Please sign below to say: I wish the Foundation to treat all donations as Gift Aid, until I notify you otherwise.

Signed ....................................................................... Date ...................................................
ITEMS REQUIRED:
PUBLICATION
QUANTITY
PRICE*
     
     
     
     
     
     
     
     
     
POSTAGE AND PACKING ON BOOKS:
  
TOTAL: