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ORDER FORM
PRINTABLE
to return to the following address:

   CANNESHOP
   	Sevice commande, 

	63 route de Lezoux

   	63190 ORLEAT    FRANCE

   TEL : + 33 4 73 68 26 10  - FAX : + 33 4 73 73 20 44
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	ADDRESS FOR INVOICE:
   Name :					First name :

   ADDRESS : 

   ZIP CODE : 		City :

   e-mail :                                                TEL (permanent ) :
 
   ___________________________________________________________________________
  	ADDRESS OF DELIVERY IF DIFFERENT :


			


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    ITEM       QUANTITY           DESIGNATION            UNIT PRICE      TOTAL AMOUNT
 NUMBER
  
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                                                                                      TOTAL       |__________


                                                                     Transport cost:    |______________|

        

                    		      NET TO PAY :        |______________|

   This order will be taken into account only accompanied by
   its entire regulation.



   PAYMENT BY :

  	(  ) Bank transfert		
    	


    

    Date and Signature :