1 box of GO - 24 tubes

1 box of Sprizzerol - 24 cans

The order will be sent to the address stated on the form below by regular postal mail after receiving the respective amount:

Name:			Title:	Mr. Ms. Dr. Prof. Rev. other   If other:
ID Number
Street:			Town:
Country:			Postal Code
Phone:			Fax:
e-mail:			Website:
IF YOU ARE UNDER THE AGE OF 18 You may not order, pay for, share the cost of, or attempt to purchase, or possess or consume any type of bevarage that contains either Alcohol.				I am over 18 I am under 18
Order
Quantity	Product		Quantity	Product
	GO Wodka Energy			GO Pure Energy
	GO Wodka Lemon			GO Sport isotonic Grapefruit
	GO Wodka extreme Energy
	GO Wodka extreme Lemon			Sprizzerol
	GO Wodka extreme Cranberry
	GO Wodka Strawberry Shot
	GO Eikohol
Please fill out the following questionaire (not obligatory)
How did you find out about us?
	I saw the product -
	in a shop		Place & Name
	in a bar		Place & Name
	in a Supermarket		Place & Name
	at an event		What event ?
	found it on the internet		What Site ?
	media/newspaper/magazine		Which one ?
	saw it on a trade show		Which one ?
	other		Please Specify

For Go-Energy (non-alcoholic) 48 Euro
For Go-Wodka 4% alcohol 52.80 Euro
For Go-Wodka 10% alcohol 60 Euro
For Sprizzerol 60 Euro
& shipping costs (shipping costs within Europe - free)

Please transfer the amount to our account for sample shipments:

Account name: D&M
Account number: 1234567890
Bank name: Bank ????????????
Bank address: ?????, Napoli, Italy
IBAN: IT39 1234 0012 1234 1234
SWIFT/BIC: XXITABCD

* You also can pay by providing credit card data (request return call).
* Please state your e-mail address as reference when transferring funds.
* Risk of loss or damage of the shipment is borne by requesting party.
* Other methods of shipping may also be requested. Additional cost will charged.