Address entry in the Intl. Register of Forwarding Companies

I would like to make the following entry. I would like to make the following entry

Title

First name

Name

Address entry Address entry

1. Address 1. Address

Address at CHF 125 / EUR 90 per year (3 issues) plus VAT in Switzerland Address at CHF 125.00 / EUR 90.00 per year (3 issues) plus VAT in Switzerland

normal

Address in bold type at CHF 250 / EUR 180 per year (3 issues) plus VAT in Switzerland Address in bold type at CHF 250.00 / EUR 180.00 per year (3 issues) plus VAT in Switzerland

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City

Company

Address

Postal address

Postcode/city

Country

Telephone

Fax

E-mail

http://

Additional address Additional address

Address at CHF 95 / EUR 65 per year (3 issues) plus VAT in Switzerland Address at CHF 95.00 / EUR 65.00 per year (3 issues) plus VAT in Switzerland

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Address in bold type at CHF 190 / EUR 130 per year (3 issues) plus VAT in Switzerland Address in bold type at CHF 190.00 / EUR 130.00 per year (3 issues) plus VAT in Switzerland

bold

City

Company

Address

Postal address

Postcode/city

Country

Telephone

Fax

E-mail

http://

Choose your currency

Please charge my credit card as follows: Please charge my credit card as follows

Mastercard/Visa/Amex

Name of the card holder

Number of the credit card

Vailidity

I enclose a banker's cheque made out to Swissprofessionalmedia AG, Basel. I enclose a bankers' cheque made out to Swissprofessionalmedia AG, Basel

Banker's cheque