Pagides Entomon PMC Nik. Gatsou 21 38333 Volos Greece Fax: ++30-24210-76244 Email sales@pmc.gr Website http://www.pmc.gr ORDER FORM (for orders up to EUR 2800) |
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FILL OUT AND FAX IT TO: ++30-24210-76244 | ||||
PRODUCT | Qty | UNIT (EUR) | SHIPPING (EUR) | AMOUNT (EUR) |
COMPLETE PRODUCTS | ||||
Insect trap PMC small dish | .....................× | ..................... | +..................... | =..................... |
Insect trap PMC big dish | .....................× |
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OFFER
1 20 Insect traps PMC small dish (For Diptera, Lepidoptera ) & bait's ingredients & instructions manual |
.....................× |
..................... | +..................... | =..................... |
OFFER
2 20 Insect traps PMC big dish (for Coleoptera and Common Fly ONLY) & bait's ingredients & instructions manual. |
.....................× |
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PARTS
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Sponge (big), 9 cm in external diameter | .....................× | ..................... | +..................... | =..................... |
Sponge (small), 6 cm in external diameter | .....................× | ..................... | +..................... | =..................... |
Total products Total Shipping European
residents only: add Value-Added Tax 19% Grand Total |
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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!) 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 Cardholder signature:________________________________________ Date (dd-mm-yy):___________________________________________ INSTRUCTIONS
Thank you for choosing PMC insect traps products! |