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(* compulsory fields)
Contact name and surname*: ..............................................................................................................................................
Institution*: .......................................................................................................................................
Department: ....................................................................................................................................
Address*: ..........................................................................................................................................
Zip Code*: ..........................City*:.....................................................Country*:.....................................................
Tel.*: .........................................................................................................................................................
Fax: .................................................................................................................................................
Email: .................................................................................................................................................
VAT or inter-community number
(compulsory for European Union member states)*:...................................................................................................
| Are you an ELRA member: | YES ( ) | NO ( ) |
We would like to order the following items:
|
ELRA Ref. |
Resource name + short description if needed |
Type of use(1) |
Quantity |
Price(2) |
(1) R = Research use; C = Commercial use
(2) Shipment fee not included
| Date of order*: | Signature*: |