Customer Registration Form
Please print-off this A4 page & fill-in as relevant, then return it to us by mail or fax...
We recommend that you phone us after faxing!
Ultima Thule, 1 Conduit Street, Leicester, LE2 0JN, England.
Orders: utle1uk@tiscali.co.uk
Shop enquiries: utle2uk@tiscali.co.uk
3:
Customer address...Your name:
Address:
x
x
4:
Mailing address, if different from customer address...Name:
Address:
x
x
1:
How will you normally make orders?...tel:
mail/letter: e-mail: fax: Your contact details...
daytime/work:
home/6pm+/Sat:
note: this should be a landline (not mobile) number!
Fax:
Email:
2:
What is your preferred postal method?...letter:
Recorded: Insured: 6:
to use a credit or debit card, list the details...
debitother[not American Express!]
Issuing bank: ________________ Your name on card: ______________________________
I declare that I am over 18, all the information given here is correct, and that I authorise Ultima Thule to process orders using the information on this form...
Your signature: _____________________________________________________________
Card number
Valid from:
Expiry: issue:
Security code:
Ultima Thule declares that all information on this form will be kept confidential. It is for the use of Ultima Thule only. It is not stored on an accessible system, and will not be passed-on to any third parties. The issue number is required on some debit cards. The security code is the final block of 3 digits printed on the rear signature strip. We can only accept registration by phone or email if we have a land-line phone number to contact you, and the goods are despatched by recorded or registered post (this costs extra) as appropriate. Presents for known/registered customers (husband/wife/family) can usually be catered for without extra registration.