CAKE DELIVERY NOTE – HLA – Heirs Forms

0700 434 7754

0912 222 2200

wecare@heirslifeassurance.com

PRESTIGE CUSTOMER CAKE DELIVERY NOTE

Please answer ALL questions in full. Use CAPITAL LETTERS.

DETAILS OF CUSTOMER:

Title (*)

Surname (*)

First Name (*)

Middle Name

Date (*)

State (*)

DETAILS OF DELIVERY:

Vendor's Name: (*)

"Thank you for being our Customer! Enjoy your special birthday treat."

Customer Feedback: (*)

Signature: (*)