ORDER FORM

First Name: Second Name:
Organization or Company:
VAT number (if applicable):
Address:
City: Province/State:
Country: Postal Code:
Phone: Fax: Email:

Title: Price: $
Title: Price: $
Title: Price: $
Title: Price: $
Title: Price: $
                                                                                                                Sum: $
                                                                                    (*)Postage & Handling: $
                                                                                                               Total: $

(*)AIR MAIL POSTAGE & HANDLING COSTS:

- 10 US dollars for each title to Europe and 15 US dollars for each title to any other country outside Europe.

    METHOD OF PAYMENT:

Bank check payable to PROGENSA sent by air mail.
Send us a proforma invoice. (Only for Companies or Organizations).
C.O.D. (Only for Spain. A supplement of $7 will be charged).
Credit Card:     VISA AMERICAN EXPRESS.

Card number: Expiration date:


  

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