Dwyer Instruments Limited
Unit 16, The Wye Estate, London Road
High Wycombe, Bucks HP11 1LH-UK
Telephone:(+44) (0)1494 461707
Fax: (+44) (0)1494 465102
ORDER FORM
1.Fill in the top boxes completely and accurately, since any errors or omissions here will delay the order processing.
2.Add any additional items, as necessary, in the empty order boxes below.
3.When you have filled the form out completely, press the SUBMIT ORDER button.
4.ALL FIELDS MUST BE COMPLETED to insure that your order is entered properly.
5.Please note a Carriage/Insurance charge of £11.50 will be added to order for delivery within mainland UK.
6.VAT will be added at ruling rate at the time of dispatch.
Bill To Address:
Ship To Address:
Contact Name:
P.O. Number:
Credit Card or Account Number:
3-Digit Security Code (last 3-digits on signature strip):
Cardholder Name:
Master-Card (M), Visa (V) or Dwyer (D):
Expiration Date:
Phone:
Fax:
ITEM DETAIL
Quantity Model Number Notes
(Click Item to EDIT)
Total:
 VAT will be charged at the prevailing rate.
Accept partial shipment?   Yes No
E-Mail Address: