Pognes & Suisses NIVON
Order form to be printed
Fax or send to NIVON
17 avenue de la Gare 26000 VALENCE
Fax:
33 4 75 44 94 68
Tel : 33 4 75 44 03 37 - E-mail :
info@nivon.com
Date
Surname - First name
Address
Postal code
Town
Telephone n°
Fax n°
E-mail
Pogne order
nothing
500 gr
750 gr
1 Kg
1,5 Kg
Suisse order
nothing
500 gr
750 gr
1 Kg
1,5 Kg
Saint-Genix order
nothing
500 gr
750 gr
1 Kg
1,5 Kg
Fleur de nougat order
nothing
500 gr
750 gr
1 Kg
1,5 Kg
Total in Euros
(V.A.T. included)
Visa card N°
Mastercard N°
Expires end
I enclose a cheque for:
made out to maison Nivon
Signature: