Face Shield Order Form

Face Shield Order Form
Name *

Title First Name Last Name
Email *
example@example.com
Contact Phone Number *

Area Code Phone Number
Delivery Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Price
A minimum of 2 Shields

Price - £5.90 + P&P

Postage & Packaging - £1.50
Paying by Card?

Complete below
Card Payments
prev next ( X )
Face Shield £ 2.95 GBP

Quantity

Subtotal £ 0.00 GBP Shipping £ 0.00 GBP Total £ 0.00 GBP
Paying by Invoice?

Complete below
How many shields do you require?
Do you have a purchase order number?
If you have a purchase order number, please fill in the box below
Company Name
(If applicable)
Invoice Address if different from above

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Marketing Communications
Lymphoedema Training Academy, or partners would like to keep you informed of other products or services relating only to your enquiry, If you do not wish to receive info please let us know. (Please note that LTA will however contact you with regards to your order)

YES please keep me informed NO thank you
For further information about how we collect and use your data, please see our Privacy Notice

http://www.lymph.org.uk/privacy-notice/
Thank you for your order!

Please note: Your order will be dispatched once payment has been received.
Should be Empty:

Price