Application Form for "Block of the Month"

Name:



Address:



Email Address:



Telephone or Mobile Number:

Card Type:



Card Number:



Expiry Date:



CVC:

(3 digits on the back of your card)

Terms and Conditions – By submitting this form you agree to the following:
• Your debit/credit card details to be securely held by Ashmead Designs Ltd. for the required period.
• 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.

Postal charges may apply for orders from outside the U.K..

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