Purchase order
To be printed

Please send it to: Maison DELOFFRE - 3, rue de la Clef ~ F-59000 LILLE

NAME ____________________________________First Name: _________________________________

Address : ____________________________________________________________________________

Zip code : _______________ City : _________________________ Country : ______________________

Phone number : ________________________________ Cell phone: _____________________________

Reference

Description
(Please specify in case the desired color, the thickness...)

Quantity

Total in €

Please draw up the bank cheque payable to:

Entreprise DELOFFRE

TOTAL AMOUNT

Carriage fee

TOTAL