Form of the “Charge acceptation FAX”

Fun Explosive
Hošαlkova 2
160 00 Praha 6

tel.: +420 - 220 515 132
fax: +420 - 220 515 133
e-mail: sales@funexplosive.cz

  
 

"Charge acceptation FAX"
 

 

Name: ………………………………………..…………………………
 
Delivery address: ……………………………………………………….
 
ZIP and country code: …………………………………………………..
  
We would hereby like to confirm your order and give you the costs.
  
See our order no.: ……………………………
  
Freight charges: ……………………………...
  
V.A.T. no.: …………………………………….
  
Card no.: ……………………………………...
 
                                    Visa      EuroCard     MasterCard
  
Expire date: ………………………………….
  

I hereby accept that the amount …………………….. ( EUR, $) will be charged to the above given card number
  

 

………………………………

………………………………

Place and date

Signature
 
  
Please fax to us a.s.a.p. for fast delivery. Thank you.
 
Best regards,
                                        FUN EXPLOSIVE