Order Sheet for ABM Mushroom
(Please print out this page and fax to +49-511-8485345.)

To:
Euro-Japan Handel
Talstrasse 4
D-30880 Laatzen Germany
Fax: 0511-8485345

<Dried Agaricus Blazei Murill(ABM)>
Dried ABM Mushroom150g (for ca. 1 month)
Euro 66，50(incl. 7% VAT） ____pce.

Dried ABM Mushroom 150g x 3 piecesk
Euro 185,- （ink. 7% Mwst） ____set.

<Postage>
Postpaket in Germany Euro 7,00
By Collect in Germany Euro 11,00

Total Euro ,

1. Name : ______________________________________________________
2. Address : ____________________________________________________
_______________________________________________________________
3. Tel :_________________________ Fax: ______________________________
4. E-Mail: _______________________________________

5. Payment

By Collect (After money received we ship goods.)
account holder : Euro-Japan Handel Sasaki
Bank : Sparkasse Hannover
IBAN : DE52 2505 0180 0900 0807 89
Account No. : 900080789
Credit Card
　　VISA Master AMEX JCB
　　Card No. ＿ ＿ ＿ ＿ ＿ ＿ ＿ ＿ ＿＿ ＿ ＿ ＿ ＿ ＿ ＿
　　valid until _____ ／ _____
　　Card Holder _________________________________
　　date of order ___________________________________

　　Signature __________________________________