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Please complete the form, print it, sign it and then send it by fax or regular mail. Fax International: +41 44 240 2624 Mail: ORGAZMIK Postfach 9608 CH-8036 Zurich Switzerland Fill in your email address so you get an order confirmation and we can also contact you in case of a problem. We reserve the right to refuse orders that have no email address. Shipping options [info]
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Delivery address (must match cardholders address) Name (First and Last Name) Street Address Postal Code / City, Town Country Email address Payment
Credit Card Number Expiration Date (MMYY) Name of Cardholder I want to place this order and confirm to be 18/21 (depending on State) years or older and agree to the Terms & Conditions signature Would you like to receive our monthly infomail? Yes, please. |
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