I, the undersigned:
Name:
Surname:
Firm:
Street address:
Postal code ; City:
Country:
Tel:
email:
N°VAT for europeans companies:
Would like to order...........copy(ies) of the book
Dalí, The Hard and The Soft (English edition ISBN 2-9521023-1-7)
at 79.00 euros + shipping costs*.
* France, colissimo suivi EUR 7,40
Europe EUR 11
Other countries EUR 25
Total FRANCE: EUR 86,40
Total EUROPE: EUR 90
Total OTHER COUNTRIES: EUR 104
Bank transfer to
Eccart sarl, Perré, 37190 Azay-le-Rideau, France
Bank account number
19406 37002 81356420001 35
IBAN-code FR76 1940 6370 0281 3564 2000 135
BIC -code AGRI FRPP 894
Date:
Signature