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Please send me the following item(s)

ITEM 1 - Code: Colour:

Size: Qty: Price £: (Total price for Item(s) 1)

ITEM 2 - Code: Colour:

Size: Qty: Price £: (Total price for Item(s) 2)

ITEM 3 - Code: Colour:

Size: Qty: Price £: (Total price for Item(s) 3)

ITEM 4 - Code: Colour:

Size: Qty: Price £:(Total price for Item(s) 4)

ITEM 5 - Code: Colour:

Size: Qty: Price £:(Total price for Item(s) 5)

Total Amount: £ (Total amount of items 1 - 6, above)

Card type:

Name : (Name as it appears on the card)

Card Number: (Please do not enter spaces)

Issue No: (Switch/Solo only - if not, leave blank)

Valid from: / Expiry date: /

Security Code*

*Security Code AVS/CV2 checks can help us to protect you against fraud. AVS stands for Address Verification Service

and CV2 is the 3 or 4 digit security code found on most cards. The security code can usually be found on the signature

strip on the back of most cards. In most cases the security code is the last 3 digits printed on this signature strip.

With American Express cards, the security code is the four digits printed just above the card number.

JANE FASHIONS SECURITY

Jane Fashions ORDER ONLINE security is automatic, powerful and transparent - ensuring a secure

environment in which confidential data, such as credit card details may be sent from people anywhere

in the world. This allows us to carry out secure transactions across the Internet.