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priorityorderform  
*** Please print, complete, and post (or fax) to us at the address below ***
DISABILITY AIDS PRIORITY (POSTAL) ORDER FORM 
METHOD OF PAYMENT(Please tick) 
 I wish to pay by:
CHEQUE POSTAL ORDER(Made payable to DISABILITY AIDS)
OR CREDIT CARD 
Please debit my VISAMASTERCARDSWITCHSwitch Issue No
Please quote your Card No and Expiry Date below:
-- /

Signature................................................... Date......................... 
Tick, if you do not wish to receive information from other Mailing Companies
 
 
DECLARATION FOR RELIEF FROM VAT
I am chronically sick or disabled (as defined below) and I am receiving from DISABILITY AIDS the goods on this order form, which are for my personal or domestic use. I claim that the supply of these goods is eligible for relief from VAT under the VAT Act 1994. Insert details of your chronic sickness or disability below. Note: There are severe penalties for making a false declaration. 

..................................................................... Signature........................................... Date.........................
 
Item No
Quantity
Catalog Ref No
Item
Colour or Size
Price Each 
(£)
Total Goods 
(£)
EXAMPLE
1
AA8145A
Folding Walking Stick
31"
24.10
24.10
1            
2            
3            
4            
5            
Total Goods  
Add Total P&P
Total To Pay  
 
BLOCK CAPITALS, PLEASE 
Mr/Mrs/Miss/Ms................................................... 
Daytime Tel No:..................................................  
Address.............................................................  
........................................................................  
........................................................................  
.........................................Post Code.................		 CHANGE OF ADDRESS/DELIVERY ADDRESS, IF DIFFERENT 
Mr/Mrs/Miss/Ms................................................... 
Daytime Tel No:..................................................  
Address.............................................................  
........................................................................  
........................................................................  
.........................................Post Code.................
 
RETAIL  OUTLETS 
75 Stonecot Hill, Sutton, Surrey.  Telephone: 020 8644 8465  Facsimile:  
, , . Telephone:  
HOTLINE  020 8644 8465