Please use the form to place an order with City & West and use the button below to send your order details to us. Give as much information as you can so that your order can be processed as quickly and accurately as possible.

Tel (020) 8885 6655, Fax:(020) 8885 6611, Email:sales@cityandwest.com

Company Name:
Date:
Contact Name:
Contact Tel:
Email Address :
Order No :

Qty	Lamp/product Type or Code	Watts	Cap	Colour

Delivery Instructions: