T-Shirts - Abode of Chaos

ORDER FORM T-SHIRTS - ABODE OF CHAOS		Price / unit	Qt	Sub-Total
	T-Shirt Borderline Biennial size S	€10,00	.........	...........................
	T-Shirt Borderline Biennial size M	€10,00	.........	...........................

Free shipping and handling until the end of Summer Total amount to be paid:				...........................
Billing and Delivery Address (Tick the box if you want an invoice ) Company.................................................................................................................... First and Last names............................................................................................. VAT number (required for EU companies).............................................................. Address (no PO Box)............................................................................................... .................................................................................................................................... Zip Code..........................State...................................City...................................... Country.................................................................................................................... Tel. (required)..................................................................................... Fax ...................................................................................................... E-mail ..................................................................................................
Full payment of Euros ………………… to be paid upon ordering (invoice sent separately) Check payable to "Musée L'Organe" Bank transfer (please contact us) Credit card: VISA / CB / EUROCARD / MASTERCARD / DINERS / AMEX card #:: ………………...………………………………………………………… Expires: .…………../……………security code (last 3 digits): ……………… In:………………………….. Date : ………. / ……….. / ………….. Signature and stamp:

Please print, fill in and sign the order form and return with your payment to: Postal address:
Musée l’Organe – Demeure du Chaos - BP 69 - 69270 Saint Romain au Mont d’or - France
Fax: +33 478 22 06 06 - Call for information: +33 472 42 17 42.