DE ESPONA 3D ENCICLOPEDIA ORDER FORM
PRINT AND SEND BY FAX TO:
(Your International Calling local code) + 34 91 521 27 22
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| COMPANY / EMPRESA: | _________________________________________ |
| NAME / NOMBRE: | _________________________________________ |
| ADDRESS / DIRECCION: | _________________________________________ |
| POSTAL CODE / CODIGO POSTAL: | _________________________________________ |
| COUNTRY / PAIS: | _________________________________________ |
| TELEPHONE / TELEFONO: | _________________________________________ |
| FAX: | ________________ |
| E-MAIL: | _________________________________________ |
| CREDIT CARD/ TARJETA DE CREDITO: | VISA ____ MASTERCARD ___ AMEX ___ |
| CREDIT CARD NAME / TITULAR: | _________________________________________ |
| NUMBER / NUMERO: | _________________________________________ |
| VALUE PERIOD/ CADUCIDAD: | _____________ |
| EUROPEAN UNION USERS ONLY: Please provide your local Tax Identification Number for the invoice. If this number is not provided, an aditional 16% need to be charged as tax | |
| EUROPEAN TAX IDENTIFICATION NUMBER | _________________________________________ |
| 9 CD COLLECION PRICE PER UNIT |
700 USD$ |
| QUANTITY UNITS |
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| COMMENTS |
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DATE :__________________
SIGNATURE __________________