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ORDER FORM T-SHIRTS - ABODE OF CHAOS Price / unit Qt Sub-Total
Women's
 

 

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Tank top little turquoise salamander on black size M

€10,00

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Tank top little turquoise salamander on black size L

€10,00

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Tank top little turquoise salamander on black size XL

€10,00

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T-Shirt Red Salamanders' heart on black size S

€10,00

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T-Shirt Red Salamanders' heart on black size M

€10,00

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T-Shirt Red Salamanders' heart on black size L

€10,00

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Men's
T-Shirt CHAOS size S

€10,00

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T-Shirt CHAOS size M

€10,00

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T-Shirt Borderline Biennial size S

€10,00

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T-Shirt Borderline Biennial size M

€10,00

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T-Shirt Borderline Biennial size L

€10,00

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T-Shirt Red Salamander size L (slim fit)

€10,00

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T-Shirt Red Salamander size XL(slim fit)

€10,00

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Women's 2006
Tank top little white salamander on black size L

€10,00

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Free shipping and handling until the end of August 2008
Total amount to be paid:
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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)...............................................................................................
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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.