ZAMOWIENIE / ORDER FORM

Wydrukowane i wypelnione zamowienie prosze wyslac faxem lub poczta do Ksiegarni Polskiej w Ottawie. Tekst zamowienia moze byc rowniez wyslany poczta elektroniczna.

Print this form, fill it out, then fax or mail it to Polish Bookstore in Ottawa.Contents of the form may also be send to us by e-mail.

Date: ___________________       Name: _________________________________________

Address: __________________________________________________________________

Telephone #: ___________________       Email: ____________________________________

Prosze przyslac nastepujace pozycje / Please send the following:

Platne / Payment by:

• VISA
• MasterCard
• American Express
• cheque
• money order

Card information:

Numer / Number: _____________________________

Data waznosci / Expiration date: __________________________

Podpis / Signature: __________________________