Order form ALSICAN

Order form

Please , copy this order form and send by e-mail : alsican@online.fr

Or print this order form and send it by postal mail to:

ALSICAN

241 boulevard du 8 mai 1945

59240 DUNKERQUE

FRANCE

Phone . ++ 33 3 28 20 32 15 / e-mail: alsican@online.fr

Order form

ALSICAN:

241 boulevard du 8 mai 1945 - 59240 DUNKERQUE - FRANCE

Name:

First name:

Address:

City:

Postal code:

Country:

Phone .:

E-mail:

Title or number and year of the canvas:

Amount:

Check O only accepted in France and Belgium

Credit Transfer O

PAYPAL O

secure payment: use PAYPAL :

Please , do not send your payment before having received the confirmation of your order form (terms of sale)

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