Order Form

I ( ________________/______________ ) (first name / last name ) autorise Gerard Vacher Entreprises to collect ......€
from my VISA card n° .... .... .... ....
expiration date .../...
to receive Liz Mc Comb recordings :
.... CD __________________________ (CD titles)
.... DVD ________________________ (DVD titles)
.... Video_______________________ (Video titles)
Total : .... €
Email : ....
Phone / Fax : ....
Writer signature: ....