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Please fill in the form using a black Pen and use CAPITAL LETTERS then post it to us at:-
Mexicana, P. O. Box 1411, Marlborough, SN8 3WZ

 

 

Your order details
Item code Description Price (£)
     
     
     
     
     

N. B. All prices include delivery in the U. K.   Total (£)

  
 

Your Payment Details

I enclose a cheque made payable to 'Mexicana' for my order - Yes/No

Your credit/debit card type – please circle

Switch/Maestro  Solo  Delta  Visa  MasterCard
Start date / valid from date where available  
Expiry date  
Switch only issue number  
16 digit card number  
Card Verification Value (the last 3 digits on the signature strip)  
Card Holder or Customers Signature

 

  
 

Your Billing Address And Delivery Details
Your name (as it appears on your credit card)  
The billing address for your credit card  
Billing address line 2  
Billing address line 3  
Billing address line 4  
County / State  
Post code / Zip  
Country (if outside the U. K.)  
Land line telephone number  
Mobile telephone number (if required)  
Fax number  
 
Delivery address if different  
Delivery address line 2  
Delivery address line 3  
Delivery address line 4  
County / State  
Country (if outside the U. K.)  
Delivery address telephone number