Order form

	Please print out the order form after filling it out completely, sign it and send it to us: FAX (+49 7151 923952). We will send you an order confirmation within one week. Thank you.

Title
Last Name
First Name
Organization
Street / P.O.Box
ZIP
City
Country
Telephone
FAX
E-Mail
URL
	Please send me the following items. I agree to your general terms and conditions of sale and delivery.
		47-1000 quickPX device	EUR 3322.00
		47-1501 Glass plate	EUR 48.00
		47-1502 Lower Reflector	EUR 13.50
		47-1503 Spare lamp set	EUR 52.00

	Alle prices plus shipping and VAT ........................................................................................................................ Date, Signature