Regalia Order Form

 Send to:  Sue Creech (MGCGB)
The Crown House
Ford, by Lochgilphead
Argyll
PA31 8RH
Name  
Address  
   
   
Postcode  
Tel.  

Item Colour/Size Qty Price each Total
         
         
         
         
         
         
         
         
         
         
         
         
UK P&P: on orders up to £10 value: £1.50
  on orders from £10.01 to £20.00: £3.00
  on orders from £20.01 to £35.00: £4.00
  on orders over £35.00: £5.00
Order total  
P & P  
Total  

Payment Details
Cash Cheque/Postal Order (Payable to: Moto Guzzi Club GB)
Card type:   Cardholders Name
      Card Number    
Expiry Date / Security No.
Issue Date   /     (last 3 digits on the back of the card)
Date   Signature