Order Form

I am interested in further information about the Boiler Discount Scheme
I am interested in a FREE, No Obligation Quote for Loft Insulation
I am interested in a FREE, No Obligation Quote for Cavity Wall Insulation

I would like to order:
Panasonic Energy Saving Bulbs
£9.99 for pack of 2	10 Watt	Quantity:
	20 Watt	Quantity:
	20 Watt	Quantity:


Radiator Panels
	£13.99 (6 pack)	Quantity:
	£24.99 (12 pack)	Quantity:

Solar Powered Torch
	£14.99 each	Quantity:

Freeplay Ranger Self Powered Radio
	£37.99 each	Quantity:

Postage and Packing (Delivery to UK Mainland only)
	Up to £15.00	£1.50
	from £15.00 - £40	£3.50
	Above £40	£7.50
Total


Delivery details
Title
Surname
Address (including postcode)
Telephone (daytime)
Telephone (evening)
Email

I have ordered items and I am enclosing a cheque made payable to 'EnergyWise Direct'
I have requested more information

Once you have completed the order form simply print it off and send it FREE to us at the following address:
EnergyWise Direct FREEPOST BM6829 West Bromwich West Midlands B70 7BR