NAME of the farm:............................................................................................................................

NAME of the breeder:.....................................................................................................................

Address:.............................................................................................................................................

Post code: .................................TOWN:.........................................................................................

Phone:......................................Fax:.........................................Email:..................................................

I want to order the following products (please fill in the corresponding lines):

Ref.	DESIGNATION	Qty	Price by unit	Total
001	Electronic transponder HP - HDX technology - Yellow color - for bovine use	...	6.00 €	................
002	Electronic transponder LW - HDX technology - Orange color - for caprine use	...	5.50 €	...............
Total amount without taxes				..............
VAT: 19.6%				.............
Total amount (I enclose my payment by cheque addressed to APIIC)				.....................

Delivery time: 2 to 3 weeks after reception of your order.

Available: YES

I ACCEPT TO ORDER

DATE and SIGNATURE

You want to order ? Just print the purchase order above (or copy it ), fill it in and send it back to us duly dated and signed with your payment by cheque to the following address :
APIIC-11 place de la Collégiale - 87210 LE DORAT