VIEWS: 7 PAGES: 3 POSTED ON: 8/14/2011
1 MERLIN – SAINT GERMAIN ORDER FORM Dear customer, Thank you for your interest in our products. The order form is composed of 3 pages. In the first page, please select the desired products and accessories using the check boxes with an “X”, specify the quantities in the relevant fields and write down the total amount. In the second page, fill in the shipping details as accurately as possible. Once the order form is complete, please send it by e-mail (as an attachment) to firstname.lastname@example.org or print it and send it by fax to 1-866-5274683 (US). Product Size Price Quantity Total Lavender scent 15cc $4.99 Lavender scent 30cc $9.99 Lavender scent 100cc $29.99 Orange scent 15cc $4.99 Orange scent 30cc $9.99 Orange scent 100cc $29.99 Sandalwood scent 15cc $4.99 Sandalwood scent 30cc $9.99 Sandalwood scent 100cc $29.99 Vanilla Patchouli Scent 15cc $4.99 Vanilla Patchouli Scent 30cc $9.99 Vanilla Patchouli Scent 100cc $29.99 Mint scent 15cc $4.99 Mint scent 30cc $9.99 Mint scent 100cc $29.99 Musk scent 15cc $4.99 Musk scent 30cc $9.99 Musk scent 100cc $29.99 Rose scent 15cc $4.99 Rose scent 30cc $9.99 http://www.merlin-cosmetics.com/saint germain Tel: 1-866-2289132 (USA Toll free) Fax: 1-866-5274683 (US) 2 Rose scent 100cc $29.99 Jasmine scent 15cc $4.99 Jasmine scent 30cc $9.99 Jasmine scent 100cc $29.99 Lemon scent 15cc $4.99 Lemon scent 30cc $9.99 Lemon scent 100cc $29.99 Shipping 5-9 days 3-5 days 1-3 days North America, Europe, Mediterranean $11.99 $19.99 $29.99 South America, Asia,Australia/Oceania $17.99 $25.99 $34.99 Africa, Middle East $30.99 $38.99 $48.99 *The prices are net prices EXCLUDING local taxes and payments which may vary from state to state and from country to country TOTAL (INCLUDING SHIPPING) $ _______________ If the billing and shipping details are the same, write them only once. Please note, the credit card charge will appear under “Power Positioning LTD.” Shipping Details Billing Details (if different) Full Name N◦.+Street P.O.Box City State Zip Code http://www.merlin-cosmetics.com/saint germain Tel: 1-866-2289132 (USA Toll free) Fax: 1-866-5274683 (US) 3 Country Phone Fax E-mail Greeting Card/ Comments Payment arrangements Credit card Bank check Wire Transfer Credit Card Type Visa Diners MasterCard Amex Credit Card Number Security Code (3/4/5 digits behind the card) Expiration Date (mm/yy) / Name on Card Bank Information for Wire Transfer Name: IDB Bank of New York Name: Credit Swiss Bank ADDR: 511 Fifth Ave. New York, NY 10017 ADDR: Bahnhofstrasse 17, Postfach 357, ABA / swift number: 026009768 CH-6301 Zug, Switzerland Account number: 08-3746-8 IBAN - CH52 0483 5007 3921 7200 0 Account Name: Power Positioning Ltd. Account number - 73921-72 *Please note – the amounts are NET, please pay your Account Name - Power Positioning Ltd. local costs to the bank. Swiftcode: CRESCHZZ63A http://www.merlin-cosmetics.com/saint germain Tel: 1-866-2289132 (USA Toll free) Fax: 1-866-5274683 (US)
"VIRTUAL LASER KEYBOARD ORDER FORM 1 MERLIN – SAINT GERMAIN ORDER FORM Dear"