To use our Mail Order Facility please print off the form on this page and post or fax to the address given below.

Coniston Lodge Hotel, Sunny Brow, Coniston, Cumbria, LA21 8HHM
TEL/FAX: 015394 41201
E-MAIL: info@coniston-lodge.com

Your Contact Details

Title:	Surname:				M.I.:
Address:
County:		Postcode:
Daytime Telephone:
E-mail address:

 
Your Credit Card Details

Credit Card Number ( Visa & Mastercard only ):
Name on card:	Expiry Date:
Signature:

 
Delivery/Recipient Details (if different from above)

Title:	Surname:				M.I.:
Address:
County:		Postcode:
Daytime Telephone:
E-mail address:

 
Your Order

Item	Weight	Qty	Price			Total
Cheques (Made payable to Coniston Lodge) Please write your address & card number on the reverse.			SubTotal
			P&P
			Total