| BASILICO FRANCE | ORDER FORM (to be printed) | |||
| Liqueur du Soleil | Public prices | |||
| Date : | ||||
| 20 Allée du Muguet | ||||
| 38120 ST-EGREVE | ||||
| 0033 (0)6 14 25 79 59 | ||||
| 0033 (0)4 76 95 72 49 | ||||
| Delivery address | ||||
| Name:………………………. | ||||
| Adress:……………………… | ||||
| ………………………………… | ||||
| Citycode, Town (country):……………………………. | ||||
| Téléphone:……………………………. | 2011 price list | |||
| DESCRIPTION | U.P | Quantity | TOTAL | |
| Green BASILICO 50cl Standard | 17,00 € | - € | ||
| Green BASILICO 50cl Fantasy | 19,50 € | - € | ||
| Green BASILICO 20cl Fantasy | 12,20 € | - € | ||
| Green BASILICO 100cl Gourmet | 31,00 € | - € | ||
| Red BASILICO 50cl Standard | 17,00 € | - € | ||
| Red BASILICO 100cl Gourmet | 31,00 € | - € | ||
| BASILICO VERT BASILICO Glasses 4cl, box of 12 | 48,00 € | - € | ||
| N Bout | ||||
| Postage and packing,French coutry only* | Subtotal | - € | ||
| 1 Bottle: 10€ | ||||
| 2 Bottles: 14€ | ||||
| 3 Bottles et + 17€ | *Postage, | |||
| Total | - € | |||
| Règlement par chèque Payment by cheque to the account of Basilico France, sending after cashing. | ||||
| Forbidden sale under 18. | ||||
| Client's signature | Date | |||
