SXELECTRONICS ORDER FORM

Qty Product Price
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Total _________
Transportation (post or courier) _________
Total amount _________

We accept Visa and Mastercard 

Full Name(as on card)
 
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Card Billing address
 
_____________________________________________________
Card No
 
_____________________________________________________
Expire date
 
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Three last digits(back)
 
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Telephone
 
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FAX
 
_____________________________________________________
Signature
 
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If you do not want to use a credit card our bank account is:Iban account number GR7401101950000019576238794
For security reasons, we do not accept this data by e-mail. The goods are sent to the card's billing address. Please sign this form and send it to Fax number +30-210-4811881