Just print this out, fill in and mail/fax.
This Title is: FOR ME / A GIFT (Please indicate) Today's Date:______/_______/_______ (DD/MM/YY) CURRENT TITLE: Mr/Mrs etc _______________________ FULL NAME:_____________________________________ ADDRESS:_______________________________________ _______________________________________________ COUNTY / STATE:__________________________________ POSTAL CODE / ZIP:_______________________________ COUNTRY:______________________________________ NATIONALITY:___________________________________ TEL.NO:________________________________________ FAX.NO:________________________________________ PURCHASER'S EMAIL:____________________________ DATE OF BIRTH:_________________________________ HOW DID YOU FIND OUR WEBSITE? SEARCH ENGINE / ADVERT / OTHER: _________________ NEW TITLE REQUIRED Viscountess, Marquess, Marchioness, Duke, Earl, Duchess, Sir, other TITLE:________________________ I the undersigned declare that the information provided is correct and true. I therefore submit this application to MBC (Dept.ET) to provide me with the above effective Title. I understand that these effective Titles are not to be mistaken for real Titles (bestowed by the State, etc) or used for any fraudulent means. Signed:...................................................... Date ..................................... All fees are charged in Pounds Sterling.
Orders will be shipped to the cardholder's address VISA / MASTERCARD / AMEX / JCB / DELTA / SWITCH / MAESTRO / SOLO* *Delete as appropriate CARD NUMBER:__________/__________/__________/__________ CVV / CSC: _________(3 digits on sig. strip or 4 digits on front top right of AMEX ) VALID FROM: ____________/ __________ EXPIRY DATE: ____________/ __________ ISSUE No. (Maestro / Solo only) _______________ CARD HOLDERS NAME AS PRINTED ON CARD:________________________ CARD HOLDERS BILLING ADDRESS: ________________________________ _____________________________________________________________ TOTAL £Stg. Inc. S/H: £________________ USUAL SIGNATURE:___________________ OTHER FORMS OF PAYMENT We accept cash in US$ or £Stg. Please send by registered Airmail. We can also accept cheques drawn on a British Bank in £Stg. and International Money Orders also in £Stg., but reserve the right to clear the funds before dispatch. Please make cheques, money orders payable to MBC. PLEASE LET US KNOW BY EMAIL WHEN YOU HAVE MAILED YOUR APPLICATION. OUR CONTACT DETAILS Airmail or Fax your Application to: MBC UK Tel/Fax: 0800 652 6641 MBC - ESTABLISHED 1990 |
|||||||||||||||||||||||||||||||||||||||