Price :............................date :........................................ 

no 146-0533972-25 which is opened at the SNCI Bank in Brussels. 

Please do mention your e-mail address bellow as a communication item. 

On your ordering form sent by e-mail, please mention : 

Your name, as figuring on your bank transfer 
Your full address  (delivering location) 
References and quantities of the selected items. 

I will receive this (these) video(s) at the following address : 

Name :...................................First name :....................... 
Address :........................................................................ 
City :......................................Post code :....................... 
Country :............................... E-mail :.............................