Standard Stirling Frame

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Declaration for relief from VAT

I am chronically sick or disabled (as defined below) and I am recieving from 4Mobility the goods on this order form, which are for my personal or domestic use. I claim that the supply of these goods are eligable from VAT under the VAT act 1994.

Title
Name	*
Address	Enter Address *
Postcode	*
Country	*
Phone number	*
Fax number
Email address
Details of sickness/disablity	Enter Details *

Please note that there are severe penalties for making a false declaration