Daytime Tel: ..................................... Evening Tel:....................................

METHOD OF PAYMENT
By Cheque -  make payable to "Harlow Council". Please remember to write your cheque guarantee card number and name & address on the back of your cheque.
Please note that, as of 1st April 2003, a 5% booking fee will be charged on all card payments for tickets

By Card: -  Charge my Access MasterCard Switch/ Visa card Number..................................................................................................

Start date.......................Expiry Date.......................................

Issue No (Switch) .............................

I authorise you to debit my credit card account to the amount of £......................

Card holder's Signature.............................................................

RETURNING YOUR BOOKING FORM

- Please check all details are correct
 - Send your completed form, together with payment to:
The Playhouse, Playhouse Square, Harlow, Essex. CM20 1LS
 - If paying by credit card you can fax us on 01279 424391
 - Please state the nature of the concessionary rate. You may be asked for proof of status on production of the ticket.
 - Preferred Seats (Block/Row/Seat No.) .......................................................................

THE FORM BELOW IS FOR PRINTING OUT ONLY