CD-rom order form

This page allows you to order our publications in a secure and easy way. If you require assistance or have any queries, don't hesitate to let us know: ludwig@ombregt.be -

Fill in this order form, print it, sign it and
fax it to :

+32(0)51687712

 or send it to:
Ombregt vof
Kanegemstraat 170
8700 Tielt / Belgium 		you can also make an order by phone:
+32/51689995
or by E-mail:
ludwig@ombregt.be

Products, together with the invoice will be shipped by Ombregt vof within two weeks upon receipt of payment.

Yes, I would like to order the following CD-roms at the price of 95 euro
Product Information    
Select product    
Postage and Packing    

The prices are inclusive VAT. All orders are billed for applicable tax rates. Total to pay:    
 
Customer Information (Bill To)    
First Name    
 Last Name    
Street Address    
City    
State    
Country    
Zip Code    
 E-mail adress:    
Payment by Credit Card    
Please note that if you wish to pay by credit card, you must print out this form, sign and date it and fax it/send it by mail to Ombregt vof.
All credit card orders are accepted via Europabank , Burgstraat 170, B-9000 Gent.
I hereby authorize Ombregt vof to bill my credit card for the summ of: :
 
VISA
MasterCard
Card Number (including last three digits)
Expiration
 
Payment by Bank transfer    

If you wish to pay by bank transfer:
  • Bank account of Ombregt vof: BE17 1420 6215 1056
  • Bank information: Fortis- Belgium / BIC n° : GEBABEBB.
    IN this case you must fill out the window for customer information and fax it to: Ombregt vof: fax nr. +32(0)51687712. : Date of bank transfer:
    • Date and signature: (The date and your signature are essential when paying by credit card)

     

     
     
    User Information    
    All CD-roms are personalized ; they have a User name and a serial number
    Please fill in the two fields you want to have on your personalized copy:
    Name    
    		 City :