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Information for disabled women about
getting help to tackle violence and abuse
ORDER FORM
Please PRINT
NAME: ____________________________
ADDRESS: ___________________________________________________
_____________________________________________________________
POST CODE: ______________ TELEPHONE NO. __________________
Name of Organisation (if appropriate): _____________________________
I would like to order the following copies of the information pack: (please tick the format/s required and write in the quantity for each)
SIGN LANGUAGE VIDEO at £10-00 each
BRAILLE at £10-00 each
LARGE PRINT at £10-00 each
STANDARD PRINT at £7-50 each
AUDIO CASSETTE at £10-00 each
FULL PACK (5 ITEMS) at £40-00 each (saving £7-50)
TOTAL: £ __________
Please tick method of payment preferred by your organisation:
1) Please invoice my organisation or
2) Please find enclosed cheque made payable to A1DD c/o UK Disability Forum,
87, King Harold's Way, Bexleyheath DA7 5RE.
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