™ McEyewear ® Teleorder-Schedule for Retailers
PLEASE PRINT THIS FORM, FILL IT OUT COMPLETELY AND FAX IT TO + 43 1 405 74 71
OR MAIL IT TO McEyewear Brillenmode, Lecon Produkte Vertriebs GmbH, Feldgasse 1, A-1080 Wien, Austria.
McEyewear®
CUSTOMER-No.
. _____________________ Your e-mail and phone no. are necessary to confirm your order. They will not be shared or sold to anyone.
NAME ___________________________________________________________ PHONE _______________
COMPANY/ regd. FIRM-No. __________________________________________________ FAX _______________
STREET ADDRESS / No. ___________________________________________________________ E-MAIL _______________
CITY / COUNTRY / ZIP ___________________________________________________________________
QUANTITY COLLECTION Mod.-No. ................................... Wholesale SINGLE PRICE in ATS PRICE in ATS
      _________ ______________
         
         
         
         
         
         
         
         
         
Shipping additional for glasses ...........................FOB..............................
SUBTOTAL  
SHIPPING (see note at left)  
EC Countries: + 20 % VAT  
TOTAL ____________
PAYMENT by:
O 1) T/T (Telegraphic Transfer)
O 2) ORDER CHECK
O 3) NOT NEGOTIABLE CHECK
O
4) BANK TRANSFER to Bank Account:
BAWAG, Kto.Nr.: 01310-711-108, BLZ: 14000
O 5) CREDIT CARD
CREDIT CARD O VISA O AMEX O DINER´S CLUB O MASTERCARD
CARD OWNER ___________________________________
CARD NUMBER ___________________________________
EXPIRATION DATE ___________________________________
   
SIGNATURE ___________________________________
QUANTITY of ADVERTISING POSTERS: ____ units POSTER No.: ____
With your order you accept our Terms of Trade and Delivery for Teleorder-Trade with Retailers..
If paying by order check or not negotiable check, please enclose with this form.