Order form – Get-to-know offer (2 x 50 ml)

Herby I order the following products:

1 bottle DOLERMA® + 1 bottle PRIMALAN® – 50 ml each
for the special price of EUR 14,90 (12,41 + 20% VAT)

Payment
>> for european cutomers: on invoice
>> for US customers: prepayment on proforma invoice

Please send the order to:
In order to work on your order we need your complete information. Please fill in at least the fields marked with * .

Address
Titel
First name*
Last name*
Street*
No.*
Zip code*
Place*
US-State*          
Other countries
e-mail
Phone


Payment:
Name of the bank
Routing symbol
Account number
Account holder
(if different from the orderer)

Delivery time: 5 to 10 days from the receipt of your order.


 Banks:
Germany: Stadtsparkasse München
Kto.Nr. 904 122231, BLZ 701 50000
BIC (SWIFT-Code) SSKMDEMM
IBAN: DE97 7015 0000 0904 1222 31

 Austria: Tiroler Sparkasse Bank AG
Kto.Nr. 3300-355603, BLZ 20503
BIC (SWIFT-Code) SPIHAT22
IBAN: AT75 2050 3033 0035 5603


 With your click on »Order now« you confirm the order procedure and you assure that you have read and accepted our GTCs (general terms and conditions).