Order Form

 

Some countries will impose custom duties, any such duties must be paid by the recipient. Please note that this order is subject to the general terms and conditions on the back of this order form. By submitting this order you agree to accept them.

 

Invoice Information

Company & contact name

 

 

 Address

 

 

 

Tel

 

 

Fax

 

E-mail

 

 

 

Item #

Unit price USD

Qty

Amount USD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL USD (transport excluded)

 

Transport to be quoted (free for orders over USD 120)

 

TOTAL USD to be charged:

 

 

Card type

(Visa, Mastercard)

 

Cardholder’s Name

 

Card number

 

Expiration date

Month

 

Year

 

 

Signature:

 

 

 

 

“The above cardholder authorizes PEF to charge for the amount indicated above as TOTAL USD to be charged”

SEND THIS FORM BY FAX : 00 33 1 49 05 45 80

PEF - 32 rue Franklin – 92400 Courbevoie – France

Tel : 00 33 (0)6 08 03 79 22 / Fax :  00 33 (0)1 49 05 45 80 / pef_fm@club-internet.fr

Head quarter : 36 rue Laborde-75008 Paris-SARL au capital de 50 000 FF-RCS ParisB398844027