These prices include VAT and shipment in Europe Shipment to
other countries add Euro 11,50 to above price.
Mail order procedure:
1. Complete form
2. Select which product(s) you want and in which volume
3. Select payment method
4. Send your form, you receive a confirmation
5. After payment clearance you receive your goods within two weeks, if not we
will contact you.
Name:
Address:
Zip:
Place:
Country:
Email:
Reference: How did you arrive at this site :
Orders the following products:
Payment: (make a choice)
WHEN REQUIRED:
FOLLOWING INFO CAN ALSO BE FAXED OR EMAILED SEPARATELY
Bank / Giro / AMERICAN EXPRESS or VISA OR
EURO/MasterCARD (19
digits of signature strip!= incl. CVC code
of three digits) :
VISA, AMERICAN EXPRESS or EURO/ MasterCARD:
Card expiration date:
Attention: Name and address as given should match Account / Card information!
Please enter your telephone number in Remarks field for verification otherwise
we cannot accept credit card.
Remarks:
Direct payment (all costs paid by you) to Postbank/ Giro: 4313865 or Bank: ABN-AMRO: 453721737
(IBAN Euro: NL49ABNA0453721737),
Qia b.v., Eersel, The Netherlands. Specify your Zip code, home number,
and orderdate in the description!!
