To complete your order please fill and fax this form:

Special order description: please write below the description and price you have agreed by e-mail with our sales office. Don't write more than 7 lines.

Billing and Shipping information
Contact Name:
Company Name:
Address:
City:
ZIP code:
State or Province:
Country:
E-Mail address:
Telephone:
Fax:
*** VAT Number
If you are located in a EEC country you must provide your valid VAT number or we will have to add 20% Italian VAT to your order total.
Credit card type:
Credit card number:
Card Security Code (3 digits)
Expiration date month/year:
Credit card holder name (as it appears on card)
*Important: write below, by hand, amount, date and Sign

I agree to debt this Order Total Amount of ................... € (EURO) to my credit card indicated above

Date .....................
Authorized Signature..................................................................

Print this form and fax it to +39-0543-796725
Important: Even if you dial from abroad you must dial the 0 in front of 543.
Special Order Form ©2004 DPS-Promatic srl via Edison 21 47100 Forli Italy
Tel.+39-0543-723428 Fax.+39-0543-796725 - P.IVA 0159970402 - Contact us...