Faizan Nationwide Order Form

Name*

Phone Number*

Alternative Phone Number*

Address*

Customer's Actual Floor Number *

Floor Number We Will Deliver*
Ground1st Floor2nd Floor3rd Floor4th Floor5th Floor5th+

Flight of stairs to the place of delivery*

Parking Available*
YesNo

Lift Available*
YesNo

Product Description*

Price (Product + Delivery Charges)

Top Up

Handling Charges

Assembly Charges

Total Amount (£)*

Select Date*

Delivery Day*
—Please choose an option—MondayTuesdayWednesdayThursdayFridaySaturday

Manager*
—Please choose an option—Faizan

Sale Captain*
—Please choose an option—FaizanRemshaDanishWalk In Customer

Payment Method*
—Please choose an option—Cash on DeliveryBank TransferCard PaymentWebsite PaidWalk In Customer

CSR Agent*
—Please choose an option—WebsiteWalk In Customer

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