Plaque Certificate   Order Form

Please print out this form and return with a cheque for £12.00 sterling for each certificate, payable to;-

“THE FRIENDS of SWANAGE PIER” 
Hon Fund Raising Treasurer, Sponsored Planks,
Swanage Pier,
Pier Approach
Swanage
Dorset
BH19 2AW

Name..........................................................................................................................................

Address......................................................................................................................................

..................................................................................................................................................

Post Code............................................................Telephone No...................................................

Signature..............................................................Date...............................................................