Box Scheme Order Form

First Name:

Last Name:

Phone (without spaces):

Alternative Phone:
(without spaces)

Email:

Home Address:

Delivery Address:
(if Different from above)

Order for (please tick)

Large box (Ј15.75)

Medium box (Ј12.65)

Small box (Ј9.65)

Potato and Onion Free box (Ј11.75)

Mini box (Ј7.95)

Extra bag of potatoes (Ј1.80)

Please deliver

Weekly

Fortnightly

Other (please state below)

other

When would you like to recieve your first box.
We deliver Thursdays, & can usually only guarantee a delivery with a week’s notice.

How / where did you find out about our box sheme?

Preferred payment method

Standing Order: Our bank details are: Account no: 70846553 Sort code: 089250 Address: The Co-operative Bank, PO Box 250, Delf House, Skelmersdale, WN8 6WT. It would assist us if you could ask your bank to use your name as the reference.

Cheque Please make cheques payable to Vallis Veg Boxes

Boxes will be left outside your front door. If you require them to be left elsewhere, please state below

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Vallis Veg
Chris Smaje, Cordelia Rowlatt, Gladys Paulus & Kane Brough
01373 472245 info@vallisveg.co.uk