PMC insect trap - ORDER FORM(b) - Stand Alone paged version


Insect trap PMC small dish (Olive Fruit Fly, Mediterranean Fly or Medfly and various Diptera)	Insect trap PMC big dish (Goldsmith Beetle, Common Fly and various Coleoptera, Lepidoptera)	Sponge (small - big)

Pagides Entomon PMC - 38333 Volos - Greece - Fax: ++30-24210-76244 - Email sales@pmc.gr - Website http://www.pmc.gr ARRANGEMENT ORDER FORM (for orders exceeding EUR 2800) FILL OUT AND FAX IT TO: ++30-24210-76244
PRODUCT	Qty	UNIT (EUR)	AMOUNT (EUR)
*COMPLETE PRODUCTS*
Insect trap PMC small dish	.....................×	EUR.....................	=.....................
Insect trap PMC big dish	.....................×	EUR.....................	=.....................
PARTS
Sponge (big), 9 cm in external diameter	.....................×	EUR.....................	=.....................
Sponge (small), 6 cm in external diameter	.....................×	EUR.....................	=.....................

Total products SHIPMENT European residents only: add Value-Added Tax 19% or provide your European number in Customer details Grand Total			EUR..................... EUR..................... ....................... EUR.....................	PRODUCT AVAILABILITY : (Filled out by PMC ONLY, if necessary)

PAYMENT
____VISA ____MASTERCARD
____WIRETRANSFER / SWIFT

CUSTOMER DETAILS

Official Company Name:____________________

Contact person:___________________________

Address:_________________________________

City, State:_______________________________

Zip or postal code:_________________________

Country:__________________________________

Internet email (please verify!):_________________

Telephone:________________________________

Fax:_____________________________________

VAT Registration Number (EU residents only, please verify!)
Please ship the designated goods according to my instructions as soon as payment is received.

Date (dd-mm-yy):_________________________

Authorized signature

CREDIT CARD AUTHORIZATION

Charge amount of (EUR):___________________

Card type (Check with an (+) sign: ____VISA ____MASTERCARD

Card number:__________________________

Issued by:_____________________________

Cardholder name:_______________________

I hereby confirm and accept the sale and I irrevocably
authorize PMC insect traps to charge my credit card
with the above amount.

Cardholder signature:_____________________

Date (dd-mm-yy):________________________

INSTRUCTIONS

Please write clearly (no continuous writing), or print.
Orders are subject to product availability. This order form is for orders with Grand Total exceeding EUR 2800. Conversion from EUR , our reference currency, to your local one may be done using the day's reported on the Internet. Try the converter at: http://www.oanda.com/converter/classic. We do not offer a money-back guarantee.
Credit cards are charged in EUR. Some credit card issuers require enhanced identification, for protection against unauthorized use of your credit card. Please be prepared to provide personal information of the holder, such us, 2-sided photocopy of the card, date of birth, passport number, etc if required.

HOW TO FILL OUT

Fill out:
1. The customer detail field.
2. At arrangement order form the Qty field ONLY.
3. At payment field the kind of payment you wish, (credit card or wiretransfer/swift). At the end e-mail at sales@pmc.gr, or fax it to: 0030-24210-76244.
We then e-mail you (or send you a fax message, please verify youfr fax number), the same form filled out with the requested Qty among with the prices and shipment.
If you agree, fill out all fields again, (products - quantity - prices - shipment - payment - credit card authorization if needed), and fax it ONLY to: ++30-24210-76244.

Thank you for choosing PMC insect traps products!

Page Setup

Custom Borders
(0,5cm X 0,5cm X 0,5cm X 0,5cm)