MANOR HOUSE WORKSHOP - ORDER FORM
WARNING: THIS IS NOT AN ON-LINE ORDER FORM, IT'S ONLY FOR CREDIT CARD PURCHASES. PLEASE COMPLETE IT IN ALL ITS PARTS, PRINT IT, SIGN IT (IMPORTANT) AND SEND IT VIA FAX TO OUR NUMBER: +39 02 66041274, OR SEND IT VIA STANDARD MAIL TO OUR ADDRESS: MANOR HOUSE WORKSHOP, VIA MACCHIAVELLI 22, 20092 CINISELLO BALSAMO (MI) ITALY
Personal Data (all mandatory, excepting the Fax and the Province):
Name    Surname 

Address    Zip   

City    Prov.    Nazione

Phone Number   Fax 

E-Mail  

Products List:
Code Product Description Q.ty Price Unit
(€uro)		 Total
(€uro)
 
Forwarding costs (previously sent to you by us)
 
Credit Card data (mandatory):

Warning: if you have choosed the wrong form because you want to pay with other in advance payment methods, click on the button below to change form withous loosing what you written above!
Credit Card Type Visa Mastercard
Registered Holder
Expire date (MM/AAAA) /
Total Price €uro
(order total + forwarding costs)
Credit Card Number

 
Sign of the Credit Card's registered holder   ________________________________

 
Print the form!