FAX ORDER FORM

PRINT THIS THEN COMPLETE ALL ENTRIES
FAX IT TO 34 91 366 06 92

You may send Credit Card Order Forms to us via FAX  by completing the 3-step form below &
faxing it to 34 91 366 06 92 or by mailing it to


Cintranaval-Defcar S.L.
Lauroeta Etorbidea, 4 48180 Loiu, Bizkaia (Spain)
Tlf: +34 902158081
Fax: +34 944638552
info@cintranaval-defcar.com



Payments can also be made by transfer to the following bank account of No :
0182 1275 17 0011704459 of Defcar Ingenieros SL, Madrid, SPAIN
Bank: BBV

STEP 1: YOUR PERSONAL DETAILS:

Note: All fields must be completed.

Full Name:__________________________________________________________
Company´s Name:_____________________________________________________

Address:____________________________________________________________

City:________________________  State:_____  Zip:____________________

Country:________________________ Phone______________________________

Fax:________________________________________________________________

E-mail Address:_____________________________________________________
 

STEP 2: YOUR CREDIT CARD INFORMATION

Credit Card (VISA, MasterCard...:___________________________________
Credit Card Number: ________________________________________________
Date of expiration: ________________________________________________
Signature: _________________________________________________________
Date of signature: _________________________________________________
STEP 3: ORDER DETAILS
Name of the Defcar module or service:_______________________________
Number of licenses:_________________________________________________
Total amount =______________________________________________________
Total amount in text: ______________________________________________
You will receive the confirmation of your purchase in one business day.
The product will be shipped to you in two business days.


Cintranaval-Defcar S.L.
Lauroeta Etorbidea, 4 48180 Loiu, Bizcaia(Spain)
Tlf: +34 902158081
Fax: +34 944638552
info@cintranaval-defcar.com