O r d e r   F o r m

                                     Please allow up to 28 days for delivery

Your name…………………………………………………………………………..

Your address ……………………………………………………………………….

Town:……………………………………………………………………

County:……………………………………Post code ………………..

Contact telephone number ……………………………………………………….

email address ……………………………………………………………………….

Please supply ……   copies of

Corncockle  @   £ 6. 50                                                       £..........

plus packing and postage: single copy £1                            £..........

Ten Poems for Performance  @ £5.00                                £..........

plus packing and postage: single copy £1                            £..........

set of 10 copies: £2.                              £..........

                                                                                                Total     £_______

I enclose a cheque/postal order payable to Diana Mitchener for       £_______

Address: Homestead Studios,  The Drive,  Loxwood, West Sussex     RH 14 OTE

Tel: 01403 751948 & 752453                          email: corncockle@tiscali.co.uk