Ordering Is Easy Print this form (see File menu or press Ctrl+P) Select products & quantity. If using the website (rather than catalogue) no codes are required Calculate the total cost per item in the Total £ box (Price x Qty) Fill in the totals box and payment details Fax or post the form or phone us with your order

FAX              01453 751 402       PHONE         01453 790999 POST           Dietary Needs Direct 25 Church Street, Stroud Gloucestershire, GL5 1JL 9NJ

Code    Product Description         Price       Qty       Total £				Please complete box with your final totals Total Cost of Products (Sum of Total £ column)   Packing & Delivery (PLEASE SELECT RATE) Total of Products < 5 Kilos Carriage = £5.95 Total of Products > 5 Kilos Carriage = £6.95       Grand Total (Products + Delivery)   Delivery Options O     Leave Delivery Card Only & I Will Follow Up O     Leave in Porch    (must be waterproof) O     Leave in Garage/Shed    (must be accessible) O     Leave in Stairwell    (must be accessible) O     Leave With Someone Else    (must be very close neighbour) Please give details here ___________________________________________________ Postal and Fax orders (Please complete & write clearly) Mr/Mrs/Miss/Ms ________________________________________________ Address ________________________________________________ Town                                         County ________________________________________________ Postcode ________________________________________________ Day Tel. & Email ________________________________________________ Method of Payment Please tick payment method. Paying by cheque? - you can still fax or phone in your order, just send a cheque along separately. Note: Goods dispatched only upon payment O    Cheque    O    Postal Order    O    Credit Card Payment by Credit Card O   Switch   (Issue No. _____)   O   Visa   O   Mastercard __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. ___ / ___ Credit Card Holder's Signature ________________________________________________ Credit Card Holder's Details (if different) Mr/Mrs/Miss/Ms ________________________________________________ Address ________________________________________________ Town __________________________ Postcode ______________