Catalogue order form

It´s ready right now! Get it!

Our brand new catalogue LAVERDA with prices and descriptions in German, English and French.

How to order our catalogue:

• by phone +49 7531 61198
• by FAX +49 753153737
• by this E-mail-form

Prices:

I want to order the following catalogues:

750 (226 Pages) € 10.00 + Postage

1000/1200 180° + 120° (Brandnew, contains 450 Pages) € 15.00 + Postage

both catalogues

Family-Name:		First Name:
co/Company:
Street/:

Country:

AT = Österreich AU = Australia BE = Belgien CA = Canada CH = Schweiz CZ = Czechische Repubick DE = Deutschland DK = Dänemark ES = Espania FI = Finland FR = Frankreich GB = England GB = Scotland HR = Croatia HU = Hungary IE = Ireland IT = Italien JP = Japan LU = Luxenburg NA = Namibia NL = Niederlande NO = Norwegen NZ = New Zealand PL = Polen PT = Portugal SB = Serbia SE = Schweden SI = Slovenija US = USA VE = Venezuela WELT = Sonstige YU = Yugoslavia xx = sonstige/others/autre

Post Code:

City/Town:

E-Mail-Address:

Phone daytime:		Phone evening:
Mobile:		Fax:

Language:

german

english

french

I can also speak:  german     english

I have already ordered parts:

I am a new Customer

I am already a customer

Warning! I have changed address!

Credit Cards:

VISA

EURO-MASTERCARD

I do not have a credit card (in this case you will receive from us information regarding alternative methods of payment)

I forward you my Credit Card datails within 48 hours :

via Phone

via FAX

(we cannot dispatch your order until we have received these details)

From where did you get our address?:

What type of Laverda do you own?:

Important information or details for an alternative delivery address: