Offer Request form

• Please answer to all appropriate questions so we can process your request adequately
• Note that this form is not an orderform

Your address
Name:*
Company:*
Address:*
City / Zip:*	/
Country:*
Phone:*
Fax:*
E-mail:*
Website:
Please make me an offer for the varieties and amounts as mentioned below
Avalim:	(min 1000)
Backlim:	(min 1000)
Gijnlim:	(min 1000)
Grolim:	(min 1000)
Herkolim:	(min 1000)
Thielim:	(min 1000)
Remarks
Remarks:
* required field