'ULTRASCALE PRODUCTS' (Customer Registration Form)
Gear Services (Letchworth) Ltd.
Unit 25,
Such Close II Industrial Estate,
Letchworth Garden City,
Hertfordshire,
SG6 1JF.
United Kingdom.
Tel: +44 (0) 1462 681007
Fax: +44 (0) 1462 681577
Fill in and return this form to the address opposite if you wish to use the 'Email Order' option on our web site. Once all the details have been processed, a customer number and key code will be issued to you. These will allow you to login and then send an order via the 'Email Order' option, without the need to supply address or card details on the order.
Delivery details
Name:
Address:
 
 
Town/City:
County/State:
Post/Zip Code:
Country:
Credit Card details (if different from delivery)
Name:
Address:
 
 
Town/City:
County/State:
Post/Zip Code:
Country:
Telephone Number:
Email Address:
MasterCard:
 
  Visa:
 
  Maestro:
 
  Solo:
 
  American Express:
 
Card Number:
       
   
       
   
       
   
       
   
     
Valid From:
    -    
  Expires End:
    -    
  Issue: (Maestro)
   
  Security Code:
       
(if present, the security code is the last 3 digits of the number printed on the signature strip on the back of the card, except for American Express cards were its the 4 digits on the front of the card at the top right hand side.)
 
Bank that issued card:_______________________________
 
Signature:_________________________________________
About your credit /debit card details:

The details you supply on this form are for the use of Gear Services (Letchworth) Ltd. and will only be used for the processing of orders you place with us. No details will be given or divulged to any other person or third party outside Gear Services (Letchworth) Ltd.
NOTES TO CUSTOMER
  1. Your customer number and key code should be registered on our web site within 24 hours of processing your details.
  2. Please note, we only accept UK-issued Maestro cards.
  3. Please inform us of any changes to the details you supply. (i.e. change of address, card expiry date etc.) Otherwise there maybe a delay in processing any order you place.
  4. If you change your credit / debit card at any time (i.e. the card number changes) a new key code will need to be issued.
  5. Your customer number and key code will be return to you by email.
  6. Please note, that registration details will not be accepted without an email address.
FOR OFFICE USE ONLY
Date Received:
Date Processed:
Customer Number:
Key Code:
ID:

Form No.: CRF081207