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1. About you
First Name
Family name
E-mail address @
Address (as you would normally write it)
Country
Convenient telephone number Country code Number
2. Your order
I wish to order:
Quantity
Item
Price
Total
Original 1930s bread bin @
25,99
Wrought-iron key @
5,99
Sliding latch @
10,99
Brass door knocker @
15,99
Ornate door handle @ 15,99
Total for my order:
3. Your method of payment
My credit card issuer
Number
Expiry date /
I have read and understood the terms and conditions and hereby authorise City Media GmbH to debit my card for the stated amount

© City Media GmbH 2001 • All rights reserved • Last updated Wednesday, October 31, 2001
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