Retail Order Form

Orders may be placed by post, fax, telephone or e-mail: Sales

To: Acantha Lifestyle Ltd, 32-34 park Royal Road, LONDON, NW10 7LN, England.
Tel: +44 (0) 20 8453 1537, Fax: +44 (0) 20 8453 1538

Miss/Mr/Mrs/Ms: ____ Name: _______________________ Surname: __________________________

Address: ___________________________________________________________________________

Post Town: __________________________ County: __________________ Postcode: ____________

Day Tel: ____________________ Evening Tel: ____________________ Fax: ____________________

Preferred Dealer or Stockist: ___________________________________________________________

Signature:__________________________________________________ Date: ___________________

Special Instructions/Orders

Cast Iron Products:

Gas/Electric Fires:

Hearths:

Back Panel/Slips Sets:

All orders are subject to our terms and conditions

Reg. No: 3299434 - VAT No. 689 9124 70