LNS Alpha 552 - Appendix B: Ordering Form

APPENDICES 10-3
ALPHA 552
APPENDIX B: ORDERING FORM
This form should be photocopied, duly filled out, and returned to your retailer or nearest LNS agent
Company name:
Person in charge:
Address:
ZIP: City:
Country:
Phone:
Fax:
Type of device:
Serial number:
Qty. Ordering no. Description
Expected delivery:
Location and date:
Signature and stamp of the company: