BUDGET ACCOUNT APPLICATION

To: Rushstamps, P O Box One, LYNDHURST, Hants, SO43 7PP, UK
Budget (Please tick)
Please limit each selection in value to _____
not exceeding:
  10 ___
  15 ___
  20 ___
  25 ___
  50 ___
100 ___ or ______  State amount
Frequency (Please tick)
Please forward my selections:
Weekly ___
Fortnightly ___
Monthly ___
Bi-monthly ___
Quarterly ___
or ______________
Please state
Name: __________________________________________________

Address: ________________________________________________

_______________________________________________________

Post Code ________________ Signature ______________________

Payment (Please tick)
I will pay by cheque/cash/Postal Order ____
I wish to pay by Bank/Giro Standing Order ____
I wish to pay by Credit Card ____

Please debit my Credit Card every ____________________________
for an amount not exceeding _________________________________

Card Number: ____________________________________________
Type of card _____________________________________________
Expiry Date: ___________________ Switch Issue No: ____________

Signature _____________________________ Date ______________

Please print out this form and mail to the address above or e-mail it us as an attachment.
Our e-mail address is here...