PURCHASE ORDER

Send to :

Jacques Tanguy
11, rue Stéphane Mallarmé
76800 ST ETIENNE DU ROUVRAY

With your payement : 13 Euros or 17 US$ per issue
Send  __ issues of then book "The Jewish Monument of then Palais de Justice of Rouen" at

Name      : ___________________________________________

Adresse : ___________________________________________

               ___________________________________________

ZIp Town : ______  ____________________________________

Country    : ____________________________________

 

                             -  Total of the order : _____ Euros
Payement  mode: ____________________________________