Evans Lichfield Ltd - Official Order Form

Evans Lichfield Ltd Official Order Form
Please fill out the following information to complete your order. You may then email your order
directly to us. Alternatively you may print the order out and fax it to us on: 01543 415455.
We will then contact you to confirm receipt of order and to confirm prices.

Sorry but we can supply Trade customers with existing accounts only. Please contact
us if you wish to open an account or if you do not know your Account Code.

If you a new customer with a price enquiry please use the account code 'NEW'

Order Details:
Please check the details are correct. To make any alterations please return to the previous page here.

Account
Information: * Account Code:

* Required * Company Name:

Contact Name:

* Phone:

Fax:

* Email:

Delivery
Information : Name:

Address:

Address:

City:

Postcode:

Date Required:

Purchase
Order #:

Special
Instructions:

Account Information:	*	Account Code:
* Required	*	Company Name:
		Contact Name:
	*	Phone:
		Fax:
	*	Email:

Delivery Information :		Name:
		Address:
		Address:
		City:
		Postcode:
		Date Required:
		Purchase Order #:
		Special Instructions: