HOME  |  ABOUT  | AUCTION   | TERMS  |   CATALOGUE REQUEST |  ORDER FORM  |   MAILINGLIST |  MAPMAKERS |  VERSION FRANCAISE

Order Form / ORDRE D'ACHAT Catalogue sur demande 

Note: Fields marked with an "*" are required .

 

*Last Name:
 *First Name:  M.I.: 
 
 
*Email Address:
 
Company Name:
 (if applicable)
VAT Registration Number:
 (if applicable)
*Address:
*City:
*State: 
*Zip/Postal Code:
*Country:
*Daytime Telephone:
Evening Telephone:
Fax:

Shipping Information

Fill in the information below if your shipping address is different from the address you listed above in your contact information.
 
Address:
City:
State:
Zip/Postal Code:
Country:

 

I would like to order the following item(s)

 Lot Number

Title

 €

 Purchasers pay in addition a flat fee of € 15.00 per order for insured registered air mail.

If you would prefer, you can fax this form to +33 (0)1 44.24.85.80

Loeb-Larocque
31, rue de Tolbiac 75013 Paris - France.
Tel. +33 (0)1 44.24.85.80 - Fax  +33 (0)1 44.24.85.80
Email:info@loeb-larocque.com