SILENT HEKTIK       Bestellung    -   Order

Formular:  ausfüllen - drucken & unterschreiben          Orderform:  fill out - print & sign  
Fax:  (+49)  02303-257071        Email:  order @ silent - hektik . com        in deutsch

firstname      
lastname       
                                 private             company
company        
VAT/ID no.     
street + no.   
zip + city     
tel. + fax.    
vehicle+year   

1. pos.         pcs   

2. pos.         pcs   
3. pos.         pcs   
4. pos.         pcs   
5. pos.         pcs   
6. pos.         pcs   
7. pos.         pcs   

payment via       
lastschrift  (without signature)   
bankname       
Bankleitzahl   
Kontonummer    

With creditcard:  Visa    MasterCard   
in advance
CC-number      
Security-code     (with signature)
Valid end      

Signature      ____________________________________________

shippingoptions:  
als Paket mit Lastschrift 
(for Germany)      as parcel with creditcard    9,70 €
                   as parcel in advance        17,00 €

shippingoptions:   Europian Union creditcard   17,00 €
(international)    Europian Union in advance   27,00 €

                   ex EU (CH)     creditcard   37,00 €

                   ex EU (CH)     in advance   47,00 €
                   overseas       creditcard   97,00 €


The undersigned acceps the SH terms and conditions.

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