2010 INTERNET ORDER FORM

30A HIGH STREET, OLD WOKING

SURREY, GU22 9ER

UNITED KINGDOM - 01483 722273

QTY	PRODUCT	PRICE Ex. V.A.T.
	EEZEE READER 2000	£199
	EEZEE READER WIDE-VIEW	£199
	CORDLESS EEZEE READER	£295
	CORDLESS HOME & AWAY UNIT	£475
	CORDLESS VIDEOSPEX	£600
	COLOUR COMBI & FLEXIBLE STAND	£449
	COMPANION 4 – B/W READER	£550
	COMPANION 4 – COLOUR READER/WRITER	£750
	POCKET READER 2	£295
	FLEXIBLE STAND	£50

TITLE	FORENAME
SURNAME
CONTACT NUMBER
ADDRESS
POSTCODE
E-MAIL

I enclose cheque made payable to VideoSpec Ltd for £ .................……...

or debit my CREDIT / DEBIT CARD

CARD No. ................ / .............. / ............... / ............. Expiry date ......../........

ISSUE No (if applicable)……………. VALID FROM (if applicable) ……./……. 

SECURITY No……….. AMOUNT £................. SIGNED........................................

VAT EXEMPTION CERTIFICATE

GOODS AND SERVICES FOR DISABLED PERSONS:

ELIGIBILITY DECLARATION BY AN INDIVIDUAL

I ……..……………………………………………………………………… (full name)

of …………………………………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………...( address and postcode)

declare that I am chronically sick or disabled by reason of: ( give a full

and specific description of your condition)

……………………………………………………………………………………………...

and that I am receiving from Videospec Ltd of 30a High Street, Old Woking, Surrey, GU22 9ER the following goods which are being supplied to me for domestic or my personal use:

…………………………………………………………………………………………………

…………………………………………………………………………………………………

and I claim relief from Value Added Tax under group 12 of Schedule 8 to the Value Added Tax Act 1994.

Signature……………………………………………. Date …………………………….

WARNING: THERE ARE SEVERE PENALTIES FOR MAKING A FALSE DECLARATION. IF YOU ARE IN ANY DOUBT REGARDING YOUR ELIGIBILITY TO RECEIVE GOODS OR SERVICES ZERO-RATED FOR VAT YOU SHOULD CONSULT YOUR LOCAL VAT OFFICE BEFORE SIGNING THIS DECLARATION.