Giffords Way
Off Kelvin Way
West Bromwich
West Midlands B70 7JR

Tel +44 (0)121 553 1910
Fax +44 (0)121 500 4919
Email info@giffords.biz
www.giffords.biz

This form is only to be used by account holders only.
If you would like to open an account please call: +44 (0)121 550 4907

Your Details
 
Name
Company
Address
Postcode
Tel
Fax
Email
Purchase Order
 
Ordered By
Account No
Order No
Delivery Details
 
Company
Address
Postcode
Tel
Delivery Date
AM PM
 
 
1. Order Details Quantity
2. Order Details Quantity
3. Order Details Quantity
4.Order Details Quantity
   
Additional information,
Special Instructions 		Pallets to Collect
YES NO
Quantity
   
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