ORDER FORM

BILL TO		SHIP TO
	name
	company
	address
	city
	code + state
	country
	phone
	e-mail

 

ART.CODE	MODEL / DISCRIPTION	COLOUR	QUANTITY	PRICE [EURO]	SUBT. [EURO]
(1) shipping charges
TOTAL

(1) shipping charges on request
(2) payment method : instructions will be send on request

note - remarks:

 

e-mail : info@nios-lighting.com

NIOS - Sint Annastraat 20 - 9820 Bottelare - Belgium · tel +32 (0)9 3625409 · fax +32 (0)9 3307475 · www.nios-lighting.com

® all models are registered - design: luc lemahieu - nios-lighting - copyright 2010 ©