Fax Order Form

To place an order by fax please print out this form, fill in the required information, and fax the completed form to +44 20 8417 1308.

If you have any questions please email info@roskill.co.uk or telephone Christine Duggan on +44 20 8417 0087

Your Order

Please confirm that you are ordering the following items:

[ ] Molybdenum: Market outlook to 2016, 11th edition 2012

Price: GBP 4500.00 / EUR 5900.00 / USD 7500.00
(Please circle your preferred currency)

Please select format:
[ ] Electronic (no despatch charge)
[ ] Hard Copy (please select method of despatch)

Total (please complete)

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Your contact and despatch

Payment

[ ] Payment had been made to your bankers: Barclays Bank plc, London SW1Y 5AX, A/C No. 30786551, sort code 20-65-82
[ ] Please invoice my organisation.
[ ] Please debit my credit/chargecard: Mastercard Visa American Express

Card Number: __________________________________ Expiry Date: ___ / ___

Name on Card: ____________________________________ Security Code: ____

(Note: the Security Code is the last 3 digits on the back of your card. For Amex, it is the 4 digits on the front of your card.)

Billing Details (if different)

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

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Confirmation

Please print, sign and date this form before sending it to us.
I agree that Roskill Information Services Ltd may charge me, where applicable, for the above items.

Signature: ______________________________ Date: ___________