SC MultiMedia SRL
84 Crisan Str., Bl.S1 Sc.1 Ap.5
Drobeta Turnu Severin,
Mehedinti 1500
Romania
Orders/Queries +40-252-316 839
Fax Order Line +40-252-316 839
Mobile +40-745-526 896
ORDERED BY:
Name: ____________________________________________________________
Please PRINT clearly
Address: _________________________________________________________
__________________________________________________________________
__________________________________________________________________
Daytime telephone: _______________________________________________
DELIVER TO: (use only if different from 'Ordered by')
Name: ____________________________________________________________
Please PRINT clearly
Address: _________________________________________________________
__________________________________________________________________
__________________________________________________________________
Daytime telephone: _______________________________________________
ITEMs ORDERED
Cod Title Quantity Item Price Total
_____ _____________________________ ________ __________ ________
_____ _____________________________ ________ __________ ________
_____ _____________________________ ________ __________ ________
_____ _____________________________ ________ __________ ________
_____ _____________________________ ________ __________ ________
_____ _____________________________ ________ __________ ________
_____ _____________________________ ________ __________ ________
Sub-total (US$) ________
P.& P. (US$) ________
Donation to the work of CMC ________
Total (US$) ________
Postage and packing included
METHOD OF PAYMENT
1. Bank Transfer:
MultiMedia SRL
Account No.: 2754749/USD, 2754768/EUR
Raiffeisen Bank, Mehedinti
6 Bibicescu Str.
1500 Drobeta Turnu Severin
Mehedinti - Romania
2. Western Union/Cheque/Eurocheque/PO/bank draft in US$
in the sum of US$ _________ payable to the SC MultiMedia SRL.
Post to: SC MultiMedia SRL
84 Crisan Str.
Bl.S1 Sc.1 Ap.5
Drobeta Turnu Severin
Mehedinti 1500, Romania.