e-mail: monamipierre@aol.com
fax : +33(0)3 44 58 25 36
ORDER FORM (to be completed and sent by e-mail or by fax): "à mon ami Pierre"
16, rue Gambetta -60270 GOUVIEUX-
rc Senlis 441782877 - tél : +33 3 44582536
DATE : _______________
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LAST NAME __________________________________first name____________________________
street,avenue,__________________________________________________________________
CITY_________________________________AREA CODE_______________________
COUNTRY__________________________phone(if you want)_____________________________
Your e-mail (if you need an answer)
_________________________________________________________________
Your payment by visa,mastercard...
- numéro__________________________________________________
- date d'expiration___________________________________________
- the 3 numbers behin the credit card ____________________________
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