Order form Luminux®
Surname First Name
Address
Post Code Town
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
3600€
900€
Shipping to foreign countries, carriage for : Suisse / Belgique / Luxembourg / Dom-Tom : 30€ U S A : 50€
Total amount
Shipping
DUE
Your method of payment
- check
- cash money order
- payment on delivery (with the additional postal tax)
- by cash card
Noter les 3 derniers chiffres au dos de la carte ......
Validity
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