FAX ORDER

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TO : JACKY BONVIN CIGARS S.A. / CH - 3963 CRANS

FAX NUMBER ++  41 / 27 /  481 . 84 .11                                

I ORDER : ..........................................................................

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MY CREDIT CARD NUMBER (VISA OR AMEX) + EXPIRATION DATE :

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FOR VISA - Eurocard ONLY CVV2 CODE 7DIGIT NUMBER ON THE OTHER SIDE

 OF THE CARD NEAR THE SIGNATURE : ...............................

SIGNATURE :

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I PREFER TO PAY BY CHEQUE, POST OR BANK   :       ...................

My E-MAIL :   .........................................................................................

MY ADRESS (+ address where you receive your Amex invoice (for Amex cards only)):

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