7/29/2019 Formato Milpa

1/1

Petrarca254,Polanco,MexicoCity,11570.T.+52(55)55313139or52036041www.teo.com.mx

BOOKPURCHASEFORM

Name:____________________________________________________________________________________________________________________________________

E-mail:__________________________________________________________________Phone:_______________________________________________________

Doyourequireareceipt(forMexicantaxpurposes;receiptscannotbeissuedexceptattimeofpurchase)?YESNO

R.F.C.(MexicantaxIDnumber;pleaseforwardcopy):_________________________________________________Folio:_______________________

CompanyName:__________________________________________________________________________________________________________________________

Officialaddress:__________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

Ifshippingisrequired,thesecostswillappearasaseparateitem.Pleaseprovidetheexactdeliveryaddress:

______________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________

Bankdepositpayment

Depositorelectronicfundstransferrequired.Accountholder:TallerEnriqueOlveraS.C.Accountnumber1313589-9FinancialInstitution(Mexico):IXEBancoS.A.CLABE(electronicbankingcodeinMexico):032180000131358991Depositreceiptorproofoftransfershouldbeforwardedto libro@enriqueolvera.comalongwiththissignedform.PaymentbyCreditCard

Cardname(selectone):AmericanExpressVISAMasterCard

Bankorotheremittingentity:________________________________________________________________________________________________________

Name(asitappearsonyourcreditcard):___________________________________________________________________________________________

Cardnumber:__________________________________________________________________________________________________________________________

Expiration:_____________________________________________Securitycode:___________________________________________________________

IAGREETOPURCHASE:

UNO$1250MXNQuantity:____________@$1250=Total:$________________MXN

EnlaMilpa$550MXNQuantity:____________@$550=Total$_________________MXN

Shipping Total:$________________MXN

BYMEANSOFTHEPRESENTPAGARE,ICOMMITUNCONDITIONALLYTOPAYORDEPOSITTHETOTALPAYABLEAMOUNT

LISTEDABOVETOTALLERENRIQUEOLVERAS.C.

_____________________________________________AGREEMENTSIGNATURE

Pleaseforwardascanofthefullycompletedandsignedformviae-mailto libro@enriqueolvera.comWerequestyouconfirmourcorrectreceiptofyourorderbytelephone.Youmustpresentyourcreditcardandastate-issuedIDtopickupyourbook.TERMSANDCONDITIONS

Bookscannotbeheldorreserved;onlybankdeposit,electronictransfer,cashpaymentorconfirmedcreditcardtransactionsguaranteeyourbookpurchase. Yoursignatureacknowledgesthattherewillbenorefundsunderanycircumstances. YoumustincludeacopyofyourRFCifyourequireaMexicantaxreceipt. BookswillbedeliveredatPujolrestaurant.Anyrequiredshippingwillbebilledasaseparatecharge.