Merchandise Order Form

St Luke's Hospice is your local Hospice in Harrow and Northern Brent. We provide care and specialist palliative treatment for our patients and offer comfort and support to their relatives and friends. Our care is provided without charge, regardless of colour, race or creed. This year our running cost are over £3 million and less than 30% is funded by the NHS. By purchasing St Luke's merchandise your support helps us to help others.

Thank you for supporting St Luke's Hospice

HOW TO PLACE YOUR ORDER
1. Please Print Form out first then fill in your name and address in BLOCK CAPITALS including your postcode.
2. Indicate your selection on the order form.
3. You may pay by cheque, switch or credit card. Please cross cheques & make payable to: St Luke's Hospice.
4. Post your complete order form and payment to: Fundraising Dept , St Luke's Hospice, FREEPOST SCE 8472, Harrow, Middlesex HA3 0BR.
5. A Donation to cover postage and packaging cost would be appreciated.

Order Form 2007

Full Name

Home Address

Telephone No.

Order Form
Item Description	Price	Total Price
Jute bag	£3.50
Frisbees	£1.00
Fleeces (S, M, L, XL)	£8.50
Drawstring Bag	£2.00
Colouring Pencils	£0.50
Gold Bauble	£0.60
Wristbands	£1.00
2008 Diaries	£1.50
Stressbuster Desk Toy	£1.00
Total goods		£
Donation (optional)		£
P&P		£
Total Cost		£

I enclose a cheque for £ ........... made payable to St Luke's Hospice
I wish to pay by Visa / MasterCard / Switch and authorise you to debit my card
for £ ..............

Card No: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Expiry Date: __ __ __ __ Issue No: __ __ Start Date: __ __ __ __

Signed ................................................. Date ......................