Bestellformular für die - M-Base
Transcription
Bestellformular für die - M-Base
M-Base Engineering + Software GmbH Dennewartstr. 27 • 52068 Aachen • Germany Fax: +49-241-963-1469 • E-mail: [email protected] Order/Bestellung Chemical Resistance of Plastics and Elastomers Number/ Product/Produkt Anzahl Price/ Preis Addition/ Summe € 490,00 € VAT/ 19% MwSt. € Total/ Endsumme € Access to Chemical Resistance Database (12 months) Zugang zu Chemical Resistance Database (12 Monate) o Please extend automatically after one year for another 12 months/ Bitte um automatische Verlängerung um jeweils ein Jahr nach Ablauf o We want to pay via invoice/ Wir möchten per Rechnung zahlen o We want to pay with Credit Card/ Wir möchten mit Kreditkarte zahlen o VISA Card* o Master Card* Name: ........................................................................................................ Company/Firma: ........................................................................................................ Address/Adresse: ........................................................................................................ ........................................................................................................ Phone/Telefon: ........................................................................................................ Telefax: ........................................................................................................ E-mail: ........................................................................................................ for EU customers VAT number:/ für EU Kunden UST.-IdNr.: ........................................................................................................ Date/Datum: Signature/Unterschrift: ........................................................................................................ ---------------------------------------------------------------------------------------------------------------------------------------- *Credit Card/Kreditkarte Credit card holder/Kreditkarteninhaber: ................................................................................. Credit card number/Kreditkartennummer: ................................................................................. Valid thru/Gültig bis: ................................................................................. CVC Card Validation Code/3-stellige KPN: ................................................................................. Date/Datum: Signature/Unterschrift: .................................................................................