Order form 

Please print out this order form and send a signed copy to:

Rainer Triller

Wolfsgasse 3

D-53225 Bonn

Germany

From 

(Please, fill in your details using block capitals)

Name:                        __________________________________

First Name:                __________________________________

Street, No.:                __________________________________

Postal Code:              __________________________________

Town (County)          __________________________________

Country:                    __________________________________

Telephone number:    __________________________________

E-Mail:                     __________________________________

Retail price of book                    €    9, 50   

plus postage and package           €    1, 45

                                                  €  10, 95

I order _________   copy / copies  of   Apprecihated  World

at a total amount of  _________   and I agree to transfer the money to

your bank account.

Date: ______________        Signature:____________________                                          

(Please state date of order on transfer slip!)

 

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