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FAX : +33 559 139 367
ORDER FORM TO USE BY FAX (Print and Fax: + 33 559 139 367)
| PERMANENT ADDRESS | DELIVERY ADDRESS If different |
| Name | Name |
| Address | Address |
| Address | Address |
| City | City |
| Zip | Zip |
| Country | Country |
| Phone (obligatory) | Phone (obligatory) |
| Fax | Fax |
PLEASE WRITE IN CAPITAL
Description |
Size | Color | Color Subtitue |
Quantity | Price Unit |
Price Total |
| Sub Total | |||
Shipping and handling |
Regular Post Priority | Express delivery by Chronopost | |
| Total | |||
| SIGNATURE (obligatory) |
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Name Card |
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| VISA | Number Card |
Expire Date | |||||
| MASTERCARD | Number Card |
Expire Date | |||||
Email : HELP