Order Form / Bon de Commande Catalogue sur demande 

 

*Last Name:
 *First Name:  M.I.: 
 
 
*Email Address:
 
Company Name:
 (if applicable)
VAT Registration Number:
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*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.
 
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I would like to order the following item(s)

 Lot Number

Title

€

If you would prefer, you can fax this form to:

FAX  +33 (0)1 44.24.85.80

Librairie Loeb-Larocque
31 rue de Tolbiac,    75013 Paris,     France. 
Portable +33 (0)6 11 80 33 75, Tél./ FAX: +33 (0)1 44.24.85.80
Email :info@loeb-larocque.com