konkursbuch Verlag Claudia Gehrke &endash; Order Form

ORDER FORM

If you don’t want to send this order form over the Internet (because it is insecure), just print it out (make sure you have filled it out as completely as possible) and fax it to the following number:

+49 7071 76 37 80

first name:

last name:

street:

country, ZIP-code, city:

phone-number:

fax-number:

e-mail:

Please tell us, which and how many items you want to order.

Example:

1 dvd maria beatty, return of ...
1 dvd Love Bites 1-3

Now chose your payment

advance invoice. Payment by bank transfer IBAN

credit card (+ 5 euro):

Eurocard/Mastercard
Visa

The credit card number:

Valid through (Month/Year):

Further comments:

first name:
last name:
street:
country, ZIP-code, city:
phone-number:
fax-number:
e-mail:

Please tell us, which and how many items you want to order.
Example:	1 dvd maria beatty, return of ... 1 dvd Love Bites 1-3