Order Form

 

[Composant FrontPage Enregistreur de résultats]                  Surname          First Name                                   Address                                 Post Code     Town                                   Tel                                 E.mail   Form to be printed and sent to : HOLISTA - BP 11 - 84870 LORIOL du Comtat - France or by FAX :  00.33.490.60.65.68   Selected ordered items Unit price Quantity Price                                                                                 Shipping to foreign countries, carriage for : Suisse / Belgique / Luxembourg / Dom-Tom : 10€ Autres Pays : 18€ *For purchases requiring only one shipping envelop such as filter sheet, addtitional filter : 3€      for the shipping of one book  : 6€   Total amount   Shipping   DUE      Your method of payment  - check - cash money order - payment on delivery (with the additional postal tax) - by cash card                                                                  Validity                                                                      Noter les 3 derniers chiffres au dos de la carte   ......