ACI Service & Vertriebs GmbH
Ostcharweg 72, 45665 Recklinghausen (Germany)
Telefon: +49 (0)2361-41514
Fax order:
| The buy by internet is comfortable and out of risk. If you nevertheless do not want to order by our online shop, we offer you the possibility to fill out a fax form and to print it afterwards. You can also fill out it the form manually. Than send it just to the following fax number:: +49 (0)2361- 4 14 12 |
| Yes, please send me the down listed articles: |
| Order number | Units | Article name | Price € |
| Customer-no. | ||
| Name: | ||
| First name: | ||
| Street: | ||
| Postcode: | ||
| City: | ||
| Country: | ||
| Telephone: | ||
| E-mail adress: | ||
| Payment method: | Cash on delivery Bank deduction by credit card Pay before delivery |
Visacard Eurocard Amex |
| by bank deduction | by credticard | ||
| Account-no.: | Card-no.: | ||
| Bank code: | Validity: | ||
| Bank: | Card holder.: | ||
| _____________________________ | _____________________________ | ||
| City, date | Signature |
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