Order Information
Phone: +44-(0)20-8493 1060
Fax:   Print this form and fax it to +44 (0)20-8885 5711
Mail:  Send this form to Polydiam Industries Ltd,
70-72 Markfield Road, London N15 4QF, England. U.K.

Terms & Conditions
Terms and conditions of sales

Shipping Information
Shipping information, costs, and policies

Order Form

Product	Item	Description	Price	Qty.	Total
				Subtotal
				Tax
				Total

Shipping Address

Name
Address
City		State
Country		Zip
Email

Billing Address
  Check if same as shipping address

Name
Address
City		State
Country		Zip
Email

Billing Information

Credit card
Name on Card
Card number
Expiration