Order form for clients from France

ORDER FORM
(Reserved to individuals in France – Valid until 1st January 2016)

Please print this order form, then fill in your order and details and POST with your payment to:

MAPPEVERBE SARL
SERVICE COMMANDES
6 CITE DES SAPINS
25450 DAMPRICHARD - FRANCE

	Ms Mrs Miss Mr Dr Prof (please tick or specify other): .............................
Surname:	........................................................................................................................................
First Name :	........................................................................................................................................
Address :	........................................................................................................................................
	........................................................................................................................................
Postal code:	......................................Town : ................ ........................................................................
Country:	................................................................................................................................................

Thank you for writing your phone and email below to help us better serve you (* optionnal) :

Phone*:	........................................................................................................................................
Email* :	........................................................................@............................................................

According to French data protection laws, you may access or modify any data that is being held about you.

Ref.	Titles	Quantity		Unit Price (Inc. VAT)		Total Price (Inc. VAT)
CPG-1	La conjugaison à pas de géant		€	8,90	€	_ _ _ , _ _
CM-1	La carte mémoire des terminaisons des 7 temps principaux		€	0,24	€	_ _ _ , _ _
CM-2	La carte mémoire des terminaisons de l'indicatif présent		€	0,29	€	_ _ _ , _ _
M90	Mappeverbe de conjugaison française en 90 verbes * out of print *		€		€	_ _ _ , _ _
C90	Mappeverbe au coeur de la conjugaison française		€	4,95	€	_ _ _ , _ _
F90	Mappeverbe fast track to French verb forms in 90 verbs		€	5,50	€	_ _ _ , _ _
PZIP6	Puzzles de conjugaison de l'indicatif présent (6x 2 pièces)		€	2.25	€	_ _ _ , _ _
R222-1	La règle à conjuguer 222 verbes * out of print *

I accept the terms and conditions of sales. Mappeverbe may wish to send you information in the future by post or email on other products or services. If you do not wish to be included on our mailing lists, please tick here . Signature: Date: _ _ / _ _ / 2015.		Subtotal			€	_ _ _ , _ _
		Postage & packing (inc. VAT)			€	2 , 9 0
		Total amount			€	_ _ _ , _ _

Payment: I enclose my cheque for € ....................... made payable to MAPPEVERBE SARL (cheque must be drawn against a bank in France) or proof of bank transfer made payable to MAPPEVERBE SARL (with no banking fees charged to us) to our Crédit Agricole bank account :

IBAN : FR76 1250 6200 0355 0163 7172 144 AGRIFRPP825.

MAPPEVERBE
6 cité des sapins - 25450 DAMPRICHARD – France
SARL au capital de 444 Euros – APE : 5811 Z - RCS Montbéliard 478 367 998

N° de TVA Intracommunautaire : FR-64-478-367-998
Site Internet : www.mappeverbe.com- Email :

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