Business Opportunity Buyers Lists Order Form

Yes, I would like to order ............................ (quantity) names

Please find enclosed my cheque ( )      Credit / Debit Card details ( )

Please make cheques payable to: Capital Westland

To the value of £....................................

Card No: ........................................................................................................

Exp Date: ................./..................  Start Date / Issue No: ................../...............

Last 3 numbers on the back of card: ................... Please note we need these numbers to process your card.

My address details are:

Names......................................................................................................

Address: ..................................................................................................

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

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

Postcode: ................................................................................................

Please supply the list :

( ) By email - my email address is: ................................................................

( ) CD Rom as a text file

( ) Sticky labels


Please complete and post this order form with your payment to:

Capital Westland
1052 Christchurch Road
BOURNEMOUTH
Dorset
BH7 6DS

Fax your card details to: 0870 136 6202