128 Concepts 
PO BOX 11236
Kings Norton
Birmingham
B30 1YA
United Kingdom

Web:   www.128concepts.com
Email:  sales@128concepts.com

YOUR ADDRESS	DELIVERY ADDRESS	
Title
First Name
Surname
Address

Post Code
Email	Title
First Name
Surname
Address

Post Code
	
PLEASE PRINT YOUR DETAILS CLEARLY	
N.B Include your email address, so we can inform you immediately that your order has been dispatched.	

Quantity	Product Description	Unit Price £	Amount £	
	EZ Shopper E-Commerce Store v1.0	12.00		
	EZ Shopper E-Commerce Store v2.0	25.00		

Postage and Shipping Costs	
For postal orders, the postage cost is fixed at £0.27 for the software only.  This applies for orders up to 2 CD-ROMs.	

£0.28

£2.00	SUB TOTAL              
POSTAGE   
TOTAL  	£
£
£            
	
For postal orders outside United Kingdom, the postage cost is fixed at £2.00 for the software only. This applies for orders up to 2 CD-ROMS or more. No more than 5 CD-ROMS can £2.00 postage costs cover.
		Tick your method of payment

                  [  ] Postal Order
                  [  ] International Order
                  [  ] Cheque

N.B Payments by cheque or postal order must be made payable to ‘128 Concepts’. We reserve the right to delay the dispatch of orders until payment has been received.  You will be notified by email that your order has been dispatched.

Thank you for your order.  Please return your completed order form to the address above.