Torrecid Glazura s.r.o. - Roudnice nad Labem

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