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Print this form, complete it and post or email to the address below. You may order up to 5 items per Order Form. If you require more, then please use multiple forms.

Name:-
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Address:-
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email/tel:-
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Product Code:-1)

Product Code:-2)

Product Code:-3)

Product Code:-4)

Product Code:-5)
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Product Description:- 1)

Product Description:- 2)

Product Description:- 3)

Product Description:- 4)

Product Description:- 5)
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Please make cheque or Postal Order for the total amount payable to GemMania and send to:-

GemMania, 1 Claygate Road, Dorking, SURREY. RH4 2PR

pajon@gemmania.co.uk

Please allow up to 28 days for delivery

Item Cost:-1)................. £

                  2)................. £

                  3)................. £

                  4)................. £

                  5)................. £

Add £2.50 carriage per item   £

Total £