EMF-Bioshield® Protection System: How to Order: Switzerland

Order Form for Switzerland

(Please print and fill out the form below)

Please send ASAP:
______ sets(s) of two elements of EMF-Bioshield®/“S2” at a cost of: 195.00 CHF

+ Shipping & Handling: 9.00 CHF + Swiss VAT at 7,6% (14.80 CHF).

Please pay by check with your order, payable to S.E.I.C. sa/Genève.

IN ORDER TO AVOID ANY SHIPPING MISTAKES, KINDLY WRITE IN CAPITAL LETTERS AND LEGIBLY (information in bold is required, the other is not). All information provided here will remain confidential and will not be used for advertising purposes.

Last Name: ______________________________________________________________

First Name: _____________________________________________________________

Address: _______________________________________________________________

ZIP: _______________ City: ________________________________________

Telephone______________________________ Fax: ___________________________

E-mail: _________________________________________________________________

Location and date: ____________________________________________________________

Signature: ___________________________________________________________

Purchase recommended by: _____________________________________________________

Send to: Jacques SURBECK, 3 rue du Léman, Geneva 1201, Switzerland
Tel. 00(41) 022-732-5540 - Fax 00(41) 022-732-2534

E-mail: seic@pingnet.ch
Web site: EMF-Bioshield.com