ORDERING FORM

Clonberne History Book

Be careful not to select the ENTER KEY or the SUBMIT QUERY button untill you have completed the Form

NAME
ADDRESS 1
ADDRESS 2
CITY
STATE/COUNTY
ZIP CODE
LANGUAGE
COUNTRY /REGION
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS

NUMBER OF COPIES WANTED AT €12.70 PER COPY + P&P


THE PRICE WILL THEN BE DEDUCTED FROM YOUR CREDIT CARD ACCOUNT (or as per other arrangements at your request).

COMMENTS:

WHERE DID YOU LOCATE OUR WEB-SITE (radio,newspaper,etc.) Should you become a customer this information will assist us in future promotion of the Web-Site.

Payment MethodVisa, Master Card, American Express

Other

Using theSubmit Query button will e-mail your information to us. Please be careful not to do so untill you have completed the Form. You can select the Reset button to clear your details.
If you experience a problem Submiting the Form you can e-mail us at clonberne7@eircom.net

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