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Yes, I would like to order the Wip chair

At a price of DEM 695.00 plus VAT.
Transport and packing: DEM 20.00 plus VAT.

Foot mat / seat laminated beech wood, natural
Free Kempten within 48 hours.

Consultation / sales
WIP Stuhl Curtius
Oeschländerweg 27
D-88131 Lindau / Germany

Tel.: +49 (0) 83 82 - 2 81 14
Fax.: +49 (0) 83 82 - 2 82 00
eMail: WIPstuhl@AOL.com

Please enter the quantity required behind the color!

in the upholstery color(s) red . . . . blue . . . . black . . . .

I ask for delivery per pay collect: . . . . or per invoice: . . . . in connect with direct debit permission

(Please place a cross for the desired method. Fill in direct debit permission!)

Please send the Wip chair to the following address:

 

 

name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

adress: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .

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fon:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .

 

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place / date                                      signature

Only to be filled in when payment is by direct debit:

name of account: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

bank, adress: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

sort code: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

account number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Please pay the Fritz Curtius Company the amount as stated above due from my account unless cancelled.

 

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place / date                                            signature