Name:
*
Address:
*
Postcode:
*
Telephone:
*
Email:
*
Please supply me each week with a box or organic vegetables and salads to the value of:
£10
£12
£14
£16
£20
(please select)
I w
ould also like fruit to the value of £
(minimum £4)
Please supply my first box week ending
(we will let you know which day)
I would like this box delivered:
Weekly
Fortnightly
Would you like potatoes included in your box?
Yes
No
(please select)
I would also like extras
(bread, eggs, dairy etc) - please specify and also state frequency - weekly, fortnightly or monthly):
I understand that I will receive this box unless I cancel by midday on Monday.
Please click
here
to read our terms & conditions - by clicking on 'Submit' you show that you agree to them.
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© 2010 Chipping Norton Organics
Unit 1, Greystones Business Park, Burford Road, Chipping Norton, Oxon OX7 5UY. Telephone: 01608 642973