Address ..................................................................................................................................

Postal code ....................... Town ............................................................................................

Telephone .......................................... Facsimile ............................................ Date .................

COSMOPOLI CONSULTANTS

ul. Kazimierzowska 52, 02-546 WARSZAWA

Tel. fax (48) 22 849 00 28

PUBLICATIONS ORDER FORM
(only for orders placed and destinations within Poland)

We order the publications as specified overleaf.

We ask you to send the ordered publications to...........................................................................

adres .......................................................................................................................................

................................................................................................................................................

We ask you to send the invoice to..............................................................................................

address ....................................................................................................................................

................................................................................................................................................

We transfer the amount of ...................... in the Polish currency (PLN) to the account:

COSMOPOLI CONSULTANTS
Account No. 72 1060 0076 0000 4011 0000 0260
In the bank: BPH S.A. O/Warszawa
 

with note: "Publications order"

Stamp and signature: