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Mobif lex
BEN BOR SARL - Dpt MOBIFLEX5 Outremont - 88340 Le Val d'Ajol / FRANCEPhone. +33 (0)329 665 339http://www.mobiflex.fr - e-mail: webmaster@mobiflex.fr
ORDER FORM for folding wheelchair MOBIFLEX - Prices 2009/2010
Quantity
Product
Price/pce (EUR excl. VAT)
Total price (EUR excl. VAT))
1
Folding wheelchair MOBIFLEX, with cushions
EUR 459.03
Shipping (shipping costs per wheelchair) : (France : EUR 220.90; countries of European Union: EUR 29.27; others countries at request)
EUR 25.08
Total excl. VAT
EUR 484.11
VAT 19,6%
EUR 94.89
TOTAL AMOUNT INCL. VAT
EUR 579.00
Payment method:
VISA/MasterCard
Card holder:
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Card number:
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Expiry date:
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Security code: (last 3 digits on the back of your card)
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In advance by bank transfer (shipping after receipt of the total invoice amount):Bank relation:: CCM SEMOUSE ET COMBEAUTE, 4 rue Henri Lebrun, F-70800 Saint-Loup sur Semouse/FRANCEBank account Ben Bor Sàrl 00057515945 38 - IBAN-No. FR 76 1027 8078 6100 0575 1594 538
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