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0300 3332222
Cymraeg
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Purchase: Single Pendant
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Who are you ordering for?
*
For myself
For someone else
Payer Details
Title
*
Mr
Mrs
Miss
Dr
First name
*
Surname
*
Phone number
*
(No spaces between numbers)
Email
*
Address
*
Lifeline user details
Title
*
Mr
Mrs
Miss
Dr
First name
*
Surname
*
Phone number
*
(No spaces between numbers)
Email
*
Address
*
Order notes
(Optional)
Medical condition
(If the person using the equipment / service, has any long-term medical conditions or any disability you pay zero VAT for our service. Please summarise the condition, medication or disability that exempts the service user.)
I declare that I am exempt from VAT
*
Yes
No