Application Form for "Block of the Month"

Name:



Address:



Email Address:



Telephone or Mobile Number:

Card Type:



Card Number:



Expiry Date:



CVC:



Terms and Conditions – By submitting this form you agree to the following:
• For your debit/credit card details to be securely held by Ashmead Designs Ltd.
• For Ashmead Designs Ltd. to charge your chosen card £24.00 every month for 12 payments.
• If you need to cancel this arrangement at any time, please telephone us to discuss this.

If you would prefer to call us with your card details, please call 07890 584386