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5.7.9.6.4 Irie Pascal (Universal Edition) Euro Order Form

No. UsersUnit PriceQuantityTotal Price
    1   112.49_____________________
    5    98.99_____________________
   10    85.49_____________________
   20    71.99_____________________
   40    58.49_____________________
  100    44.99_____________________
Shipping
& Handling     4.00_____________
TOTAL_____________

[  ] Check/Money Order enclosed

Name:_______________________________________________________

Address:____________________________________________________

City/State/Province:________________________________________

Country/Postal Code:________________________________________

Telephone:_______________________________________ [optional]

Email Address:___________________________________ [optional]

How did you hear about Irie Pascal?_________________________

_________________________________________________ [optional]

[  ] Tick this box to join the Irie Pascal mailing list.

Please do not send cash. Make checks or money orders payable to Irie Tools. All prices are quoted in Euros and are guaranteed until December 31, 2005. Please allow two to four weeks for delivery. If you fill in your email address you will be notified by email when your order is shipped.

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