Bon de commande pour achat d' automates et de boîtes à musique

ORDER FORM

E mail : tilproduction@online.fr

Print this order form

Return to homepage

Reference

Quantity

Reference number of the tune
(For Reuge
musical 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
6,50 euros	17,50 euros		15,00 euros		19,50 euros		29,50 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 :

___ ___ / ___ ___

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