ORDER FORM
Upon receipt of your order, you will be sent a license agreement which should be returned to ELDA duly signed by the legally authorised person in twofold.

Please, return this form to:

ELDA S.A.
9, rue des Cordelières
75013 Paris
Tel: +33 1 43 13 33 33
Fax: +33 1 43 13 33 30
Email: mapelli@elda.org
http://www.elda.org

(* 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*: