'The Severn Forty Nine' Order Form
(right click and select "print")

Please use BLOCK CAPITALS                                                            Please allow 21 days for delivery

Name:___________________________________________________________________________

Address:_________________________________________________________________________

_____________________________________________________   Post Code:_________________

Contact Telephone Number:_______________________________    Date:______________________

No of unframed prints required:___________ @ £49.30 inc £2.00 P&P UK

No of framed prints required:___________ @ £69.00 plus £25.00 P&P UK

Donation at own discretion: £______________        Total Amount Payable: £_________________

Cheques payable to: "FRIENDS OF LOCOMOTIVE 4930 HAGLEY HALL"

Post to :-
Friends of Locomotive 4930 Hagley Hall
Cherryholme
Pound Bank
Far Forest
Kidderminster
Worcs
DY14 9DG