Order form for buying automatons, androids and music boxes in the website of the TIL Productions firm

ORDER FORM

E mail : tilproduction@online.fr

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Reference

Quantity

Reference number of the tune
(For Reuge, Lutèce and Jobin
music boxes)

Price*

TOTAL

TOTAL AMOUNT IN EUROS

POSTAGE**

TOTAL PRICE

* Prices are inclusive of tax (TTC) for France and EEC
Prices are exclusive of tax (HT) for the rest of the world.

** POSTAGE

France	European Economic Community		Rest of Europe		USA Canada Africa		Asia Australia South America
8,50 euros	17,50 euros		20,00 euros		30,00 euros		36,00 euros

METHOD OF PAYMENT

By Credit Card (Visa)

By Credit Card (Eurocard/Mastercard)

Name:

...................................................................................

First name:

...................................................................................

Adress :

...................................................................................

Credit card number :

__ __ __ __-__ __ __ __- __ __ __ __-__ __ __ __

Zip code:

....................................................................................

City: ......................................................................

Date of expiry : CVV code :
(3 last numbers)

___ ___ / ___ ___ ___ ___ ___

Country : ............................................................

E mail : .................................................................

Name of the owner :

......................................................................................

Phone number:

....................................................................................

Date : .................................

Signature (Obligatory) :

Please return this order form to:

T.I.L. Productions - Galerie "Le Sévrien " - 99/103, rue de Sèvres - 75006 Paris - FRANCE