Astrid Leisner and Son

Astrid Leisner and Son
 

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Personal information
First name *
Last name *
Address *
 
Zip code *
City *
Telephone *
Alt. telephone
Child name
Birthday
Family doctor
Special doctor / nurse
Supplementary note
Email

Ordering

Number of Petit Budget at 531,25 Kr  
Number of Petit Advance at 937,50 Kr  
Number of Stationary (including 2 sheets) at 1262,50 Kr  
Number of sheets at 262,50. (232,50 kr if ordered with alarm)  
Number of drawsheets at 93,75. (73,75 kr if ordered with alarm)  
Payment *
 

1) Prepayment at bank to bank transfer:
 Fionia Bank / REG.: 0745 ACCOUNT: 765 56 98021
 BG Bank     / REG.: 0910 ACCOUNT: 3264130
2) Cash on delivery cost kr. 45,00