Order form

By means of undermentioned form, You can send to us e-mail order. For the successful sending of the form, it is neccesary to fill up the by (*) marked fields.


Client

Name:*
Organization:
Company reg. number:
Tax reg. number:
Telephone:*
E-mail:*

Invoicing adress

Street:* house no.:
Town:* Postcode:
State:*

Ship-to-address consistent with invoicing address


Goods

Goods name (code) Unit Quantity

add more goods


Cash on delivery: yes  no 
Despatch: yes  no 


Main page|About company|News|Products|Price lists|References|Contacts upwards

copyright © 2010 Glazura s.r.o. - Roudnice nad Labem webdesign Vendys graphics