CON_FaxOrd

Name, Surname:

Company, Function:

Street:

ZIP Code:

City:

State:

Country:

Phone, Fax:

Order for ____ piece(s) "Proceedings Holography 2000"
Price per piece 35,00 Euro

Order for ____ special package(s) "Proceedings Holography 2000"
AND Catalogue from Exhibition Holography 2000 St. Poelten/Austria
Price per package only 60,00 Euro

Austrian tax (20%) and delivery costs not are included.

Delivery costs: 16,00 Euro

Total Price: Euro _______________________

Payable to:
Account no. 00001903186
Bankcode: 32880
Bank: RAIKA Tulln (Austria/Europe)

Payment with (please check):
O Visa; O Mastercard.

Card Number, Expiration Date:

Name of Card Holder:

Date, Sign of Cardholder:


	Holography 2000 Proceedings, Catalogue Fax Order Form Please fill in and send per FAX (we accept Fax- an Mail Orders) to Holography Center Austria, Fax +43 2275 8210 Name, Surname: Company, Function: Street: ZIP Code: City: State: Country: Phone, Fax: Order for ____ piece(s) "Proceedings Holography 2000" Price per piece 35,00 Euro Order for ____ special package(s) "Proceedings Holography 2000" AND Catalogue from Exhibition Holography 2000 St. Poelten/Austria Price per package only 60,00 Euro Austrian tax (20%) and delivery costs not are included. Delivery costs: 16,00 Euro Total Price: Euro _______________________ Payable to: Account no. 00001903186 Bankcode: 32880 Bank: RAIKA Tulln (Austria/Europe) or Payment with (please check): O Visa; O Mastercard. Card Number, Expiration Date: Name of Card Holder: Date, Sign of Cardholder: