Order Form in English

To order in total security: simply print, fill in and send by mail this order form.
In order to help us to serve you quickly, please make sure to complete all the requested blank boxes (* = must be completed).

Company Name (when appropriate)

Family Name* First Name*

e-mail Address* (where we can contact you)

Delivery Address* Street
ZIP Code City

Country* Tel

I want to order the following products and quantities:
(please refer to the internet shop page for details)

Article Designation	Qty	Unit Price			Subtotal PLEASE SELECT A CURRENCY
Article Designation	Qty	$US	euros	Swiss Francs	Subtotal PLEASE SELECT A CURRENCY
BOOK soft cover (please specify the language)		39	39	59
BOOK hard cover (please specify the language)		49	49	74
Archival Collection PRINT mounted, signed and numbered		542	542	813
Archival Collection PRINT mounted, non signed (1)		298	298	447
CD-ROM of the web site (x1)		20	20	30
CD-ROM of the web site (x10)		178	178	267
handling and shipping charges (2)	1	19	19	25
Total

(1) For the archival collection prints, please mention below the name of the portraits:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

(2) Indicative handling and shipping charges per unit (subject to confirmation at reception of your order).
An exact calculation will be done at reception of your order and communicated to you.

I want to pay the total amount as follows:

by check by bank wire transfer

Please send this form by mail to
Jaydie Putterman
Château Les Cigales
F-30400 Villeneuve-lez-Avignon
France

A confirmation receipt and an invoice including the definitive shipping costs will be sent to you accordingly. The goods will then be shipped to you after receipt of your payment.