Heritage Orderform

	HERITAGE MAPS - ORDER FORM Simply print this page, than place your order by telephone, fax or post

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Description	Framed Limited Edition Ł125.00	Mount Limited Edition Ł90.00	Framed Open Edition Ł19.99	Open Edition Ł14.99	Total Price
Aberdeen					Ł
Bath					Ł
Canterbury					Ł
Chester					Ł
Herstmonceux					Ł
Lancaster					Ł
Hampshire					Ł
Sussex					Ł
Portsmouth					Ł
Yorkshire					Ł
Lake District					Ł
Devon					Ł




	Postage and Packing: Please add Ł6.50 for orders to be delivered within the U.K., Channel Islands/Eire, Europe, USA/Canada, Japan & Rest of World please e-mail for price.

Postage & Packing	Ł

Total Due	Ł

Payment Options:


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	I enclose a Cheque / Postal Order for ÂŁ ___________ made payable to "Rockey" ( In UK Sterling only )


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	Please debit Ł ___________ from my credit card account:


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Delta


	¨

Diners Int


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Mastercard


	¨

Switch


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JCB


	¨

Visa


	Card Number:


	__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __


	Issue Number: __ __

Expiry Date: __ __

			Switch Only

	Valid From: __ __


	Name on Card: _____________________________


	Signature: _____________________________

Card Holders Details:


	Title:______ Initials:______ Surname:_________________________ Address:______________________________________________________________________________________ Postcode:______________ Daytime Telephone Number:___________________________________________


	*Please note: each item is prepared individually, so please allow 28 days for delivery


	Post to:


	The Art of Leslie Rockey, 35 Dacre Road, Herstmonceux, East Sussex, BN27 4LP, England, U.K.


	Fax to:


	+44 (0) 1323 831550