Name*

Job title

Company Name

Company Location

European Union Country Other Country

Company VAT / TVA number (*required for EU companies)

Street*

City*

State/Province

Postal Code*

Country*

Telephone*

Please include: Country and area codes
e.g: +44-123-4567890

Fax (*Required for all companies)

E-mail*

Web site

Please charge my credit card:
VISA
MASTERCARD/EUROCARD
DINERS CLUB
AMERICAN EXPRESS

Credit Card number

e.g. 1234-5678-9012-3456

Expiry date

(MM/YY, i.e. 12/07)

Corporate Card    Personal Card

Company name on card

(for Corporate cards only)

Card holder's name

Card holder's date of birth

(MM/DD/YY, i.e. 03/27/66)

Cheque will be sent to Artech Publishing Srl,
    Via Gramsci 57, 20032 Cormano (MI) Italy

I will make a bank credit transfer payable to Artech Publishing Srl,
A/c no. 134501/63,
Intesa Sanpaolo, Branch no. 2396,
Bank coordinates: ABI 03069; CAB 33000
Cormano (MI), Italy.
Swift code: BCITIT33396
IBAN: IT 07E0306933000000013450163
(the documentation sent to Artech Publishing Srl by your bank must specify your complete address and the name of the GlassOnline service you have ordered)

N.B. After receipt of payment Artech Publishing Srl will invoice you.