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ORDER FORM FOR ECG WEEKLY FUEL PRICE SERVICE Subscriber details Name. Position. Company Name. Email. Card number. Expiry date. Card holder s signature. Signature. Please complete this form and return by mail to ECG at ECG Diamant Building Bld. Tel. GSM. Billing details Company name and address as you would like it to appear on the invoice. Postcode. Country. VAT No*. VAT will be added for sales within Belgium and for EU Companies without a VAT number. We apply for annual subscription 100 VAT where applicable for the year 20 Invoice will be sent by email unless otherwise requested* Notes - ECG reserves the right to review pricing of this service from time to time. Subscriptions run for complete calendar years only i*e* 1 January to 31 December. The full annual fee is payable regardless of the start date of the subscription* The subscription will not commence until payment has been received by ECG* st Payment details We will pay By Bank Transfer please send me an invoice By Credit Card Please debit my card Visa Master Eurocard/Diners/Am*Express Card holder s name. Tel. GSM. Billing details Company name and address as you would like it to appear on the invoice. Postcode. Country. VAT No*. VAT will be added for sales within Belgium and for EU Companies without a VAT number. Country. VAT No*. VAT will be added for sales within Belgium and for EU Companies without a VAT number. We apply for annual subscription 100 VAT where applicable for the year 20 Invoice will be sent by email unless otherwise requested* Notes - ECG reserves the right to review pricing of this service from time to time. We apply for annual subscription 100 VAT where applicable for the year 20 Invoice will be sent by email unless otherwise requested* Notes - ECG reserves the right to review pricing of this service from time to time. Subscriptions run for complete calendar years only i*e* 1 January to 31 December. The full annual fee is payable regardless of the start date of the subscription* The subscription will not commence until payment has been received by ECG* st Payment details We will pay By Bank Transfer please send me an invoice By Credit Card Please debit my card Visa Master Eurocard/Diners/Am*Express Card holder s name. Tel. GSM. Billing details Company name and address as you would like it to appear on the invoice. Postcode. Country. VAT No*. VAT will be added for sales within Belgium and for EU Companies without a VAT number. We apply for annual subscription 100 VAT where applicable for the year 20 Invoice will be sent by email unless otherwise requested* Notes - ECG reserves the right to review pricing of this service from time to time. Country. VAT No*. VAT will be added for sales within Belgium and for EU Companies without a VAT number. We apply for annual subscription 100 VAT where applicable for the year 20 Invoice will be sent by email unless otherwise requested* Notes - ECG reserves the right to review pricing of this service from time to time. Subscriptions run for complete calendar years only i*e* 1 January to 31 December. The full annual fee is payable regardless of the start date of the subscription* The subscription will not commence until payment has been received by ECG* st Payment details We will pay By Bank Transfer please send me an invoice By Credit Card Please debit my card Visa Master Eurocard/Diners/Am*Express Card holder s name.

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