Order Form
Print this page or obtain a PDF order form from OrderForm.pdf
Order Number of Copies: ……..
Your Full Name:_____________________ E-Mail (required)________________________
Company:_________________________________________________________________
Address 1:_________________________________________________________________
Address 2:_________________________________________________________________
City:______________________________________________________________________
State/Zip (Province/Zip):___________________Country:____________________________
Total Payment (including shipping and handling): ___________________________________
Payment made in full (circle one):
1. via credit card (US$ only): Card type(circle one): VISA- Master- Discovery-American Express
Card Number:___________________________Expiration(mm/yy):________Security Code:___
Your signature:_________________________________________
2. via Paypal (to gdeboeck@mac.com) in US$, Can$, UK Pounds, Euro or $A or
-
3.in Europe via bank transfer in Euros to account 743-0402251-06 Jos Dermout, B-1700 Sint-Martens-Bodegem, Belgium
Send Order via e-mail to FlemishDNA@dokus.com,
snail mail to Dokus Publishing, 3850 North River str, Arlington VA 22207
or Fax to +1 703 534 8827
Please provide a shipping label for each address where copies should be send.
Copy and fill out the following shipping label.
If you order more than one copy and like copies to be send to different addresses,
please provide as many shipping labels as required:
Shipping Label------------------------------------------------------------_-------
SHIP TO:
___________________________________________________________________________
Address 1:
___________________________________________________________________________
Address 2:
___________________________________________________________________________
City:
___________________________________________________________________________
State/Zip (Province/Zip):
___________________________________________________________________________
Country:
___________________________________________________________________________
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All overseas orders will be shipped via US Priority Mail, requiring just 6-10 days for delivery.
For bulk orders of 10 or more copies please inquire about price and shipping discounts.
E-mail: FlemishDNA@dokus.com
To order on-line via e-maginativegifts.com Click here.
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