Mail Order Form

Please complete this form as fully as possible.

Please write discount code where applicable in the box opposite
Home Address Title First name Surname Daytime telephone Address Town / City County Postcode Email address Fax	Delivery Address Title First name Surname Daytime telephone Address Town / City County Postcode

If ordering medicines it will help use to make sure you receive the correct preparation by completing the boxes below as fully as possible.

Your Doctor Doctor's name Doctor's Address Town / City County Postcode Travel information Countries visiting Please note: If not the sole user please add details of medical conditions / medication / allergies of other travellers who will be taking this medication

Medical Information Any medical conditions Any medication being taken at present time

Please note that if ordering prescription only medicines they must be accompanied by a Private Prescription from your Doctor.

Items Required
Product description & size	Quantity	Unit Price	Total Price
		Please send my order by Express Delivery for an additional £5.00
		Please send my order by First Class Delivery for an additional £1.00
		Total

Please note that VAT is already included on postage where applicable and there is NO charge for delivery by Royal Mail Second Class Post within the UK.

Payment Details
Please tick
Cheque*/Postal order for £ make payable to Travelpharm
Credit / Debit Card
Visa Mastercard Switch Other (please state)
Card Number
Card Valid from / Expiry date /
If switch card, please give issue number
Three or four digit auth number (on the back of card)
Total £
Signature

How did you find us

	Word of mouth
	Repeat order
	Search engine	(please specify)
	Magazine	(please specify)
	Newspaper	(please specify)
	CampsInternational.com
	Homeway Travel with Care
	Winchester Travel Health Clinic
	Surgery Recommendation
	Air Miles
	Other	(please specify)

Delivery

No charge for second class delivery within the UK. Orders will leave travelpharm WHEREVER POSSIBLE within 72 hours by first class post (please allow for weekends). All medicines will be despatched by recorded delivery

Returns Policy

If you wish to return items after you have purchased them then please pack carefully and return to TravelPharm. We will issue a refund on receipt. Medicines cannot be returned once they are purchased as they cannot be used or re-issued once they have left TravelPharm. If there is a problem please contact us to discuss it.

VAT on orders sent abroad

VAT will be deducted from all orders except those to the European Union Countries.

Postal Address

Please post completed form to the following address:

TravelPharm
Unit 10 D
Mill Park Industrial Estate
White Cross Road
Woodbury Salterton (Nr. Exeter)
DEVON
EX5 1EL