address 1 :
address 2 :
postal code : ..... ..... town :
country : ............ ....... date :
................................................................................ ( delivery requirement : yes no ) ..................... <

> GOODS ........................................................................................................................................................

the goods are :.. packaged in bulk
number of pallet(s) : ......... type of pallet :.. europe lost
weight (tonnes) : .... ........ floor in metres :
type of goods : .......
hazardous goods : ...... yes ......no
n°ONU :........... ........... class :
packaging : ................
customs procedures : ........................ <

> DELIVERY ....................................................................................................................................................

postal code : ..... town :
country : ...... ...... date :
.................................................................... ( delivery requirement : yes no )
particular instructions : ....................... <

> YOU ARE ? ...................................................................................................................................................

name compagny : ......... ......... contact :
would you like to receive an answer by : . e-mail : .
.......................................................... fax number : . tel number :

>>> ................................................................................................... ....................... <