Lieferung an (delivery to, indrizzo):

NAME (name, nome):

STRASSE (road, via):

PLZ/ORT (postcode/town, postale/luogo):

TELEFON (telephone, telefono):

FAX:

E-MAIL:

LAND (country, pease):

Zahlung (payment, pagamento):

	Nachname (nur in Österreich, Deutschland, Schweiz), Contrassegno (solo in Austria, Germaina, Svizzera).
	Kreditkarten (credit card, carta di credito)
	VISA	Karten Nr. (card no.):             ___________________ Gültig bis (validity, durata):      ___________________ Unterschrift (signature, firma):  ___________________ Datum (date, data) :                  ___________________
	EUROCARD/MASTERCARD
	AMERICAN EXPRESS
	DINERS CLUB INTERNATIONAL

Bitte Ihre Bestellung nur schriftlich (Fax oder Brief).
Please, order in writing only (by fax or letter). Per favore inviate il Vs.ordine tramiele fax o. lettera