Order form

Please Print and complete this form and send it with your payment to:

Cisca Ltd. 14 Cypress Park, Esh Winning, Durham, DH7 9JB

Name:____________________________________________

Address___________________________________________

______________________________Postcode____________

Tel:______________________________________________

E-mail:____________________________________________

Cheque/Postal order made payable to "Cisca Ltd."

Date of Ordering_____________________

How do you know about our Cisca Saltpipe? _____________________

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Please retain this copy for your reference:

Date of ordering.......................................

Qty..........................Salipipe, Qty........................Elipipe

Total amount £............................of cheque/postal order (delete as appropriate)

please allow 3-5 days before cheque to clear before delivery.

If you have not received saltpipe within 7 days, please call (0191)373 4425