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NAME: ____________________________________________________________
PHONE: ____________________________
ADDRESS: _________________________________________________________
CITY: __________________________________
STATE: ______
POSTAL CODE: ___________________________
COUNTRY: _______________________________
METHOD OF PAYMENT : (please mark your choice)
VISA: __ AMERICAN EXPRESS: __ MASTERCARD: __
BANK THAT ISSUED CARD: ___________________________________________
CARD NUMBER : ____________________________________________________
EXPIRATION DATE: __________
CARD HOLDER´S SIGNATURE: _________________________________________
LANCASTER WATCH : (please enter the code-number and the price of the watch you choose)
CODE & PRICE: ___________________________________________________________
TOTAL FOR MERCHANDISE: $_______
HANDLING CHARGES: $9.95
GRAND TOTAL: $_______
SPECIAL INSTRUCTIONS / COMMENTS:
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MAIL THIS FORM TO:
MICHAEL SARLIS 24, ETHNARCHOU MAKARIOU STR. (TSOUVALA ARC.)
85100, RHODES-GREECE
OR FAX TO:+30-241-64524
Sarlis Gold Creations is the authorized dealer of Lancaster's watches in Greece. Thank you for shopping at
