Please make Cheques  payable to Pipe Squeez International Ltd

1 Willow Park Crescent
Glasnevin North
Dublin 11
Ireland.

Please Note:

Pipe Squeeze Intl. can accept printed mail orders accompanied by Cheque, PO, or Bank Draft.
Or if you would prefer to order by Credit Card then please use the Print & Fax option.

Please supply ________ Pipe Squeez's ^TM @ IR£23 Punt each
€29.20 Euro's or equiv. local currency
this includes Tax @21% and P&P.

Deliver to

Name

: _________________________________________________________

Address:
: _________________________________________________________

: _________________________________________________________

: _________________________________________________________

: _________________________________________________________

Signature: ____________________________________

Position in company: ____________________________________