Order Form
Customer
PFEIFER SEIL- UND HEBETECHNIK GMBH
Geschäftsbereich BAUTECHNIK
Postfach 1754 · D-87687 Memmingen
Company
Street
Fax +49 (0) 83 31-937-342
Postcode, City
Contact
Telephone
Telefax
Project
Order for PFEIFER VS® System
PFEIFER VS® Box
PFEIFER VS® Rail
PFEIFER VS® Rail T100
PFEIFER VS® Long Box
PAGEL-VS®casting mortar Please order from: Pagel-Spezialbeton GmbH & Co. KG, Wolfsbankring 9, D-45355 Essen,
Tel. +49 (0)201/68 50 411, Fax +49 (0)201/68 50 415, Internet: www.pagel.de
Order confirmation
(will be completed by PFEIFER and faxed back to you!)
Please order in multiples of the packing unit (mesh box or cardboard box).
Item
Type
The order is subject to the PFEIFER Conditions of
Sale and Supply with which you are familiar.
Qty.
Please state all dimensions in mm
Ref. No.
Price each
in EUR
Total in EUR
Total price per item
in EUR
EUR
plus packing and freight
Delivery address
(only complete
if different
from ordering
address)
21
Date and signature
PFEIFER SEIL- UND HEBETECHNIK GMBH