Der Katalog.

ORDER FAX TO
DAN PIPE
Cigar & Company
Hafenstrasse 30
D-21481 Lauenburg
Fax-No. ++ 49 41 53 - 59 89 69
Credit Card Company: AMEXCO DINERS VISA EUROCARD
Card number:
Sender Customers Nr.:
Name:
Street:
DAN PIPE Frickert & Behrens KG Hafenstrasse 30 D-21481 Lauenburg Tel.: ++ 49 41 53 - 59 89 0 e-mail: pipe@danpipe. de
I want to order from your current catalogue according to your sales conditions: (Minimum order value € 60,00)
how many item number (Best.Nr.) name of item page price total
I accept that goods and additional postage will be charged on my Credit Card.
City: Post code:
Country:
Telephone: Fax:
E-mail adress:
Date of expiry: additional security number (obligatory):
(AMEXCO: four figures - DINERS, EUROCARD, VISA: three figures)
..................................................... ........................................................................................
Date Signature
11/2008