fRoots Lifetime Supporter Form

Print out this Order Form and post it to:
Southern Rag Ltd
PO Box 337
London N4 1TW
England

(Outside Europe) Please mail my copies by air/surface mail. (Circle preferred method)

Payment by Cheque

I enclose a cheque/PO/IMO for ..............
Please make cheques payable to Southern Rag Ltd.


Payment by Credit Card

Please charge my Visa/Mastercard/Switch Card No:


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Security number if present (This is the last 3 digits of the printed

number on the signature strip on the back of your card.) ........

Switch issue number (if applicable) ..............


Expiry Date: ............................

with the sum of  ..............


Signature: ..........................................................

Destination Name and Mailing Address

Name: ...............................................................

Address: ............................................................

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F.M.S. undertakes not to store your credit card number on our computer. As soon as your order has been processed, it will be promptly deleted.