THE MULTIMEDIA INTERACTIVE HYPERTEST CDROM BURNS ORDER FORM NAME

The Multimedia Interactive hypertest Cd-Rom "BURNS"

The Multimedia Interactive hypertest Cd-Rom "BURNS"

Order form

Name: ____________________________________________________

Surname: ____________________________________________________

Role/Position: ____________________________________________________

Institution/Company:___________________________________________________

Address: ____________________________________________________

City/Country: ____________________________________________________

Phone : _________________________ Fax: ______________________

V.A.T./ Fiscal Code:____________________________________________________

Cost: 80,00 Euro + Shipping

Please, send me ______ copy (ies) of Cd-rom "Burns" in  Italian  English language

Total Enclosed: _____________ Euro (include cost shipping)

Payment:

 Check n°: ____________________ Bank: _____________________________

 Bank Transfer in favour of: INFORMED Italia s.r.l.

c/o BANCA NUOVA Piazza Strauss, 7 - Palermo

IBAN: IT82 F051 3204 6847 8457 0133 329 BIC: BPVIIT3T784

Please return to:

INFORMED ITALIA s.r.l.

Attn. Dr. Loris Scozzari

Via Francesco Paolo Di Blasi, 49 - 90143 Palermo Italy

Fax: +39 091 307937 - E-mail: [email protected]