ORDER FORM

To be printed and to be send to following address :
Jean-Paul Fournié - 65 Avenue Général de Gaulle - 81120 Réalmont
Tél : 05 63 79 07 36 - fax : 05 63 79 07 37 -
Web site : www.princedecocagne.com
VAT 5.5% included
    Date :          ........................................
    Name :         ........................................  Firstname : ......................................
    Address :     ....................................................................................................
                       ....................................................................................................
    PostCode :   ................................         Tel :     ...........................................
 
 
 
            Réf           Description                Quantity            Unit price              TOTAL 

                   Signature                                               TOTAL VAT included : .......................................
           Bon pour Commande
                                                                                Postage VAT included : .......................................

                                                                                NET TOTAL : .......................................
    Mode of payment :
    I will pay on delivery + postage ( current rate )
    I include in my order :                       Bank cheque
                                                            Postal cheque
                                                            Postal order
    Payable to  Jean Paul FOURNIE - 81120 REALMONT

                            Postage :
        ¤ Order to 0 to 76,50 Euros .............................................................................. 9,50 €
        ¤ Order to 76,50 to 152,50 Euros ....................................................................12,50 €
        ¤ Order to152,50 to 457,50 Euros .................................................................. 15,00 €
        ¤ Order of more than 457,50 Euros ........................................................................ FREE

                           Warning :
Postal supplements will be charged in cases of express delivery or special requirements. For refrigerated shipments, please consult us.