Walkley Clogs Order form
 To place an order with us, fill in the form below, then print out and fax or post it to us.
Style of Clog
1st
Choice
Colour
2nd Choice
Colour

Choice of
sole
Clog
Size
Qty
Price
per
pair
P&P
Total
                 
              GRAND
TOTAL
 
HOME ADDRESS
Name

Address


Telephone

Fax

Email


DELIVERY ADDRESS
(IF DIFFERENT)

    

METHOD OF PAYMENT

We accept Visa, Mastercard, Delta, Connect, Switch and Cheque.
(Please make cheques payable to Walkley Clogs and include your name, address and cheque card number on reverse.)

Card Type


Credit/Debit Card number


Expiry Date


Switch Issue No:

3 Digit security No:

Cardholder's Name


Special Instructions or additional information about your order

Please now PRINT this form and post or fax to:
Walkley Clogs, Unit 10, Mount Pleasant Mills, Midgley Road, Mytholmroyd, Hebden Bridge, West Yorkshire, HX7 5LR.
Tel: 01422 885757 Fax: 01422 885755