Shop Order Form Your DetailsName* First Last Phone*Please leave your phone number. We will call you when your order is ready to collect.Order ready Confirmation*Phone meText meEmailPlease leave your email address so we may contact you when there are changes to this service. Your OrderCustomer OrderAvailable Items*Please select the items you would like to order. Milk Bread Bacon Loo Roll Butter 6 eggs Tin of Beans Tomato Soup Packet of Pasta Dolmio Ragu Sauce Block of Cheddar Ham Cornflakes Orange Juice Tea Bags (Yorkshire Tea, 40 bags) Coffee (Nescafe, Jar) Biscuits Dairy Milk Pringles Kit-Kat (6 pack) Order Total £ 0.00 How do you wish to pay*Choose your method of payment from the options below:Add to my accountPay by PayPalPay by chequeShop Account Number*Click the submit button below to proceed to the secure PayPal payment gateway. Once there you may pay using funds from your PayPal account or pay by card. Please note, if you wish to pay by card you do not need to have a PayPal account.Please make your cheque payable to the Titchmash Village shop and leave in the box provided at the shop.GDPR*I agree that the shop will keep my details... bla-bla-bla... I agreeNotesPlease add more information here...CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.