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Please be so kind as to print this page and send it to the following fax number:   0039-031-540064

PURCHASE ORDER FORM

Date*......................................................................................................... EUROMODEL Snc Fax 0039 031 540064 Payment: Anticipated Delivery: ex factory Name*..........................................Surname*............................................... Society*....................................................................................................... Address*...................................................................................................... City*...............................................Code*.................State*.......................... Vat Number.**.............................................................................. ** if in U.E. Address_2................................................................................................. (for the delivery only if different from the mentioned one) City...............................................Code................State........................... Phone ....................................Fax ............................................. Article* Quantity* Description* Price without IVA/VAT*                                                                                                                      Total order (without IVA/VAT)*   Dear customer we would like to inform you that the informations you are giving us on this form will create our customers files and can be used for promotional purposes. If you do not want to receive any promotional material, if you want to cancell your file or if you want to modify it please write us to the following address: EUROMODEL Snc  Via Aldo Galli, 11 - 22100  Como (CO) -Italy- Customer comunications: .................................................... .................................................... .................................................... .................................................... .................................................... ................................................... ................................................... Customer signature* .................................................. � Urgent order. Delivery only trough forwarder within......................... � If the order is not complete I accept partial shipment � Only one complete delivery

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