ORDER FORM

information for the sender:
Your entries are used conform to our web site privacy policies: see link: (legals)

Please note:
Fields that are marked with * are mandatory, otherwise the form can not be transmitted.

subject:
	billing address:
title:
name 1 *:	Please specify your name or company name
name 2:
street / house number *:	please type in street and house number
post office box:
county / zip code *	please enter your zip code
city *:	please type in your location
I am / we are a new customer:	no yes
customer number:
	contact person:
name *:	please type in the last name of the contact person
first name *:	please enter the first name of the contact person
phone number *:	please enter your phone number
facimile number:
email *:	please enter your email address Wrong format! Please check.
your website:

	your purchase order:
order text *:	please enter your order or message
	delivery:
desired delivery date:	please enter the desired arrival date. wrong format! DD.MM.YYYY please check
desired shipment mode:
	delivry address:
shipping address same as billing address	no yes

shipping address (if different from billing address)
Please check before sending the form, whether all necessary information is entered. If you wish, print this side before sending it. After successful submission you will receive a confirmation page but without your entries. If you like to have a confirmation, please notify us. Thank you for your order.
	confirmation:
order confirmation:	no yes