Order by  Fax or mail
Credit Card     

You have just to fill up the form, and print it.
   No data are sent on Internet.

Then mail of fax the form to:

TechSystems 
Maillefer AC
Grande-Rue 51
CH 1317 Orny
Switzerland

Fax + 41 21 866 63 53

 

Your order :

pce(s)
pce(s)

Accessories

3 m. extension cable Quantity :   at 15.- CHF / each

Shipping and packing charges  (Post Priority)
CHF 
 post_priority.gif (32263 octets)
Clic on the map 

 

Card's owner.        Card
only Eurocard / Mastercard and VISA card are accpted for the moment.

Name Surname  *
Card number * nnnn nnnn nnnn nnnn
Valid * (ex. 08/01 ou 08/2001)
Address *
ZIP / City * *
Country *
e-mail *
Tel (1)
Fax (1)

* compulsory

Delivery address (1)    Leave blank if identical.

Name Surname 
Address
ZIP / City
Country
e-mail
Phone
Fax

(1) For the credit card owner safety, if the delivery address is different from owner's card, we will contact him for a confirmation. Please include your telephone / fax number and hours to join to you.

Comments :

How did you find about PeneloP ?

Magazin ? Which one ?
Number
Web Site ? Which one ?
Search engine (Google, etc.) Which one ?
Other : please specify

Thank you, your answer will help us !

Place:                                                    Date:

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