Modifications Fax Order Form.
Please fill out carefully.

Please Remember All Products Will Be Sent To The Card Holders Address.

The modifications staff  take great care with credit card orders. Any information submitted by credit card to us will be dealt with the upmost security. All information will be processed by authorised office staff only. All information sent to modifications shall NOT be passed or shared or discussed in any form.
Your privacy and security is our first priority.

Charges appear as “Modifications” on your card statement.
Your current Host and IP address has been logged in case of any fraudulent use of a credit card.

All Prices Are In GB Pounds

NO CREDIT CARD SURCHARGE !!!!!

PRINT & FAX TO 07092224049 ( UK ) +44 7092224049 ( International )

Please enter your details, fields marked with * are required!

Contact Name*

Business Name

Phone Number*

Mobile Number

Fax Number

E-mail Address*

Enter Cardholder's Name & Address exactly as shown on Credit Card statement!

Card holder's Name as on card*

Street Address*

City / Town*

State / County*

Zip / Postcode*

Country*

Please Enter Your Card Details

Type of Card *

Card Number *

Exp. Date * (mm/yy)

Valid From Date (mm/yy)

Issue Number * (Switch & Solo)

Issuing Bank or Card Company

When using Switch & Solo please put your issuing number in the box

Please Type The Product Below

Qty

UK Recorded Delivery £3.00, UK Special Delivery £5.00, Overseas & International £7.00

CLICK HERE TO RETURN TO MODIFICATIONS

After you FAXED this form you will receive an e-mail whether your order has been authorised by your credit card company. This may take up to 12 hours, Once your order has been authorised it will be sent out the same day. If you have any questions please feel free to call us on (+44) 01142398088 (International).

If You Have Any Problems With This Form Please E-mail Us

sales@modifications.net