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 An die
 Bergische Universität -
 Gesamthochschule Wuppertal
 Fachbereich Mathematik
 z.Hd. Frau Stefanie Krivsky
 D-42097 Wuppertal
 Fax No. +49 / 202 / 439-2912
  
  
  
  
 Please supply:
  
  
 
| .......... set(s) of Wuppertal-posters (English) | 
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| .......... set(s) of Wuppertal-posters (German) | 
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.......... set(s) of Berlin-posters (English)
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| Price (at cost):  | 
DM 20,00 / set of 5 Wuppertal-posters  | 
(EUR 10,23) | 
 
 | DM 10,00 / set of 3 Berlin-posters  | 
(EUR 5,12) | 
 
 
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Shipment costs (incl. packing)
 for each consignment of approx. 4-6 sets:
  
| Europe  | 
Economy | 
DM 16,00 (EUR 8,18) | 
 
| Overseas | 
[ ] Premium  | 
DM 33,00 (EUR 16,88) | 
 
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[ ] Economy  | 
DM 18,00 (EUR 9,20) | 
 
 
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| Address:  | 
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| Payment | 
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Credit Card | 
[ ] American
Express  | 
 
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[ ] Master Card  | 
 
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[ ] Visa  | 
 
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No.: | 
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Card holder's name: | 
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Expiry date:   | 
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Bank transfer  | 
 (free of charge for the payee) | 
 
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Payee: Universitätskasse Düsseldorf | 
 
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Account No. : 4 051 710  | 
 
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Bank: WestLB Düsseldorf, Bank Code 300 500 00 | 
 
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Reference: W/2811/07126 | 
 
 
  
  
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