D.P.E. S.A.R.L. au capital de 50.000 Francs - SIRET 420.091.118.00018 - APE 744 B

ORDER FORM

Fill in, then Print and return to :
DPE SARL - B.P. 41 - 33038 BORDEAUX CEDEX - FRANCE
dpe.sarl@worldnet.fr

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YOUR CHOICE :

REF :	TITLE :	PRICE :
REF :	TITLE :	PRICE :
REF :	TITLE :	THIRD VIDEO FREE !
REF :	TITLE :	PRICE :
REF :	TITLE :	PRICE :
REF :	TITLE :	THIRD VIDEO FREE !
REF :	TITLE :	PRICE :
REF :	TITLE :	PRICE :
REF :	TITLE :	THIRD VIDEO FREE !
FORWARDING CHARGES :
NO CERTIFIED MAIL: 10 $ or 6 £
CERTIFIED MAIL: 15 $ or 8 £
TOTAL AMOUNT OF FORWARDING CHARGES :
TOTAL AMOUNT OF YOUR ORDER (WITH FORWARDING CHARGES) :

PAYMENT (to enclose with your order form) :
Cash	Cheque to the order of DPE	Postal order to DPE

Thank you to remind us your E-mail address:

E-mail Address:

I WANT RECEIVE MY ORDER AT THE FOLLOWING ADDRESS :

NAME :		CHRISTIAN NAME :
ADDRESS :
POSTCODE :	CITY :		COUNTRY :

I am more 18 years old.	PRINT NOW YOUR ORDER FORM (to return us with your payment)
DATE :
SIGNATURE :

To steer clear of all risks of computing fraud, we refuse at present all payments by credit card.

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