FAX-order form                        MICRO TECH LAB

Please dial our FAX number +43-316-324763

Delivery Address
Name
First name
Company
Street
Zip Code, Town
Country 
Phone
Fax
Email

Invoice Address
Only necessary when delivery address and invoice address are different
 
Name
First name
Company
Street
Zip Code, Town
Country 
Phone
Fax
Email

Choose mode of payment 
 
VISA Card
Master Card/Eurocard
Diners Club

Card holder:

Card number:

Expiry date:
Invoice (Proforma Invoice by Pre-payment)

 
For EU (European Union): If you have a VAT (IVA, TVA) number, please indicate it in this field. Otherwise we have to charge the VAT in accordance to the law.

Our products are delivered by DPD, Priority parcel and EMS
 
EUROPE_PRIORITYEurope Priority parcel , 3 to 7 business days
Euro 20,--
US $ 31.4
WORLD_PRIORITYWorld Priority parcel, (7-15 business days )
Euro 25,--
US $ 39.25
EUROPE_EMSEurope EMS, 1 to 3 business days (like DHL)
Euro 52,--
US $ 81.64
WORLD_EMSWorld EMS, 2 to 6 business days (like DHL)
Euro 55,--
US $ 86.35
Price for EU (European Union) VAT (IVA, TVA) not included

I order
pieces  ordering code Description...................................................... Price 
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .
. . . .

Example:
1
#DA37LC LM Digital adapter with C-Mount thread                                     
Euro xxx.-- 

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