Order Form
Name   Country   Cust.-No.  
Street   Postal Code/Location  
Phone/Fax   EMAIL  
Car type   Chassis No.  
Without phone number we can´t proceed the order.
Picture- / Pos.-No. Demonination Quantity Price
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       

Placement of an order will be taken as an acceptance of our terms and conditions of sale. All prices in EURO include VAT and packing, exclude postage.

I wish the following payment
quadrat.gif (878 Byte) by Credit Card quadrat.gif (878 Byte) by bank transfer in advance

quadrat.gif (878 Byte) Euro/MasterCard quadrat.gif (878 Byte) VISA quadrat.gif (878 Byte) AMEX quadrat.gif (878 Byte) Diners

Name on the card _____________________________

Card number ________________________________

Exp. date  (MM/YY) ________________________________
Date _________________ Signature ___________________________
Hausanschrift:
Im Ohl 69
D-59757 Arnsberg		 Telefon:
+49 (0) 2932
70 00 20		 Telefax:
+49 (0) 2932
8 39 15		 Internet:
www.wallothnesch.com
info@wallothnesch.com		 Bankverbindung:
Sparkasse Arnsberg-Sundern
BLZ 466 500 05   Kto.-Nr. 25 296