Nordic HF Proceedings supplementary form required for all credit card orders.
Thank you for your order. After having submitted the web order form,
please print,
fill out and fax this form to Combitech AB, Fax no.: +46
470 420 42
Order for Nordic HF Proceedings. Check one option: [_]CD-ROM, all conferences 86/89/92/95/98/01/04/07. Enter number of discs: _____ [_]Original conference binder(s). Enter number of binders (years): _____
Check and enter the total order amount in one of these currencies: [_]SEK (each CD/binder 990:- ) : _________ [_]EURO (each CD/binder 110:- ) : _________ [_]USD (each CD/binder 150:- ) : _________
Please charge my credit card with SEK/EURO/USD: ___________ (please include VAT if applicable)
Note that Swedish VAT (+25 %) shall be included in
the total order amount above for
all orders within
Sweden.
For orders within the EU (outside Sweden) the VAT
shall be included if no valid VAT number was
entered on
the web order form, or enter now on this form. Orders outside the EU
shall not include the VAT.
VAT
number: _______________________
Check type of credit card: [_]EuroCard* ------------| Check two boxes below for an affiliated* card only: [_]MasterCard* ----------|--[_]Swedish Bank card: [_]VISA* ----------------| [_]Cash OR [_]Credit
Enter card number (printed number on card): __________________________________
Enter card expiration date (printed date on card): ___________________________
Enter name of card holder (printed name on card): ____________________________
Signature of card holder (your signature on back side of card):
________________________________ Date of order: ______________
Full address for postal delivery of your order: [_] Address is equal to the web order form.
OR
[_] Use full address entered here:
__________________________________
__________________________________
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END OF FORM