Please provide the following contact information:

Name**
Title
Street address
Address (cont.)
Post Town
County
Post Code
Country
Telephone**
FAX
E-mail**

 Please provide the following ordering information:

Quotation**

 Subject to approval of the requested quotation, please select your preferred method of payment.

 Please make cheques/bankers drafts payable to Acantha Fireplaces Ltd and allow 5 working days from quoted delivery time. Regrettably, COD is no longer available.

  CREDIT CARD : Please choose your card MasterCard Visa Delta Solo Switch

Card Number
Expiry Date
Issue Number	(Solo or Switch)

 Reg. No. 5423708 VAT No. 689 9124 70