ORDER
NAME
Firstname :
Mr
Mrs
Miss
Adress :
Post code - Town
Country :
E-mail :
Phone :
Référence
Price
Quantity
Total
Historique Livre-CD
15 €
X
=
€
S'amour dont sui espris
10 €
X
=
€
Chansons anciennes
10 €
X
=
€
Troubadours & Trouvères
10 €
X
=
€
Carriage Europe
4 €
+
0
4
€
Carriage World
7 €
+
0
8
€
Write us :
Total =
€
Orders with paiements will be send immediatly.
Paiement with :
International chek : Xeremia CCP 3 896 77 K
Bank transfert : IBAN: FR03 2004 1010 0703 8967 7K03 831 BIC: PSSTFRPPLYO
Date :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
2016
Please print this page and send it with your paiement to :
XEREMIA 10 avenue Paul Delorme F 69580 Sathonay Camp - Tél : (00 33) 04 78 23 76 21