Order form – Standard

Hereby i order:

>> DOLERMA^® – antiseptic solution

	Bottle(s) – 100 ml / EUR 14,90 (12,41 + 20% VAT) each
	Bottle(s) – 250 ml / EUR 28,90 (24,08 + 20% VAT) each

>> PRIMALAN^® – finest almond oil

	Bottle(s) – 100 ml / EUR 13,80 (11,50 + 20% VAT) each
	Bottle(s) – 250 ml / EUR 26,80 (22,33 + 20% VAT) each

>> DOLERMA^® – antiseptic oil for the nailfold

Bottle(s) – 7 ml / EUR 6,95 (5,79 + 20% VAT) each

Prices include shipping and handling (except for US customers)

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

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*
State*
Others
e-mail
Phone number

Payment:

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

Delivery time: please allow 5 bis 10 days from the receipt of your order.

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

Österreich: 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).