Pro email form

First name

Last name

Address

Address (continued)

Town/City

County

Country

Postcode / Zip Code

Daytime telephone

Mobile telephone

E-mail address

Cardholder's name

Card number

Security code

Type of card

Expiry date

Issue number

Is registered Cardholder's address as shown above? Checking the box confirms “YES”.

If “NO”, please show it in the text box opposite.

Professional/School Name or Qualification

DIVE SCHOOL &

PROFESSIONAL/INSTRUCTOR

ENQUIRY/ORDER FORM

Email your enquiry to RescuEAN using

this form and ‘clicking’ SUBMIT button below.

Unless you are ordering items, please do not complete

Credit Card details section.

MESSAGE BOX BELOW

Please show your full contact telephone numbers including country codes.

If ordering, please show items required in the text box. We will email a formal quotation to you for acceptance.

No money will be debited from your card until RescuEAN has received your email confirmation that the quotation for items and P&P costs are acceptable to you.

You can use this form, thereafter, to make payment and a formal credit card sales receipt will be sent along with your order.

If you are UK or EEC VAT Registered, please show your VAT number in box below.

EEC Business customers, please also show your VAT two letter country code in box below.

If you would like a copy of this page, please use your ‘print facility’ BEFORE submitting.

Please click ‘Back’ on your PC if you decide not to send.