DANIEL SCHMITZ ROSES

DANIEL SCHMITZ ROSES

Roses du Temps Passé

Fax: (0032)80770533 E-Mail: schmitz-rose@skynet.be

MY ORDER DS ROSES

Variety		Quantity	Price	Total Price










		Postage & package Belgium: 8.50€
		Postage & package EU:15.00€
		TOTAL:
Payment:
By EUROCARD:	nr (16numbers) expire: (mm/yy)
By VISACARD:	CVcode: = last 3 digits of account number panel (see ex.)
	(Diminution will be done on the day your package is sent. We will contact you.)



CASH*	*only if you collect your roses at Malmedy.

Name:
E-mail:
Adress:
Post Code, location, country:
Tel/fax:
Date: Signature:

If certain varieties are missing, I wish to receive another near variety as a replacementyes no

This order slip can be printed and sent back by fax (0032)80770533or by letter: DS ROSES Bellevaux,19 A 4960 MALMEDY