Informatic Department

The following reference number must appear on all mail, delivery document or invoice :

Reference number : 9605 AA

This order-blank is to be send back by

E mail : belsoft@mail.interpac.be

Date
Manager
Sending
Payment by
Internet
Banking transfer

Quantity
Unit
Description of the article
U.P.
Amount
SCRVT220
$80,00
-
-
-
-

Total out of tax
V.A.T.
21%
Expedition cost
$ 2,00
Other
TOTAL

1. Please send your invoices in duplicate.

2. This order must be strictly paid in conformity with the prices, conditions and kinds of delivery as above mentionned .

3. Payment over banking transfer

Account N° 195 - 0131872 - 28

Crédit Général Rue Samson, 25 7000 Mons Belgium

Company :

Address :

Phone :

Fax :

E mail :

Authorised by BELSOFT

on 1/10/96