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Order Form

ORGANIZATION DETAILS
Name: VAT-nr: Contact person: Address: Telephone and Fax: E-mail:

Parque Tecnolgico Johannes Gutenberg, 5 46980 Paterna - Valencia (Spain) tel. (+34)963 186 434 fax: (+34)963 755 695 alh@farmamundi.org www.farmamundi.org

Benguet, Zamboanga, Tagaytay, Hospicio S. Jos, Leyte y Santa Rita

CONSIGNMENT DESTINATION
Name: Contact person: Address:

Teleph. and Fax ***: E-mail ***:

*** ALWAYS NECESSARY FAX OR E-MAIL FOR AIR FREIGHT

DELIVERY ADDRESS
Name: Contact person: Address:

Telephone and Fax: E-mail:

Delivery conditions A) Ex warehouse, Valencia B) Freight will be added at buyers costs and risk Expected Date of Delivery : Mode of transportation: Sea By road Air Postal mail

Signature of the legal representative and Stamp of the organisation:

We hereby declare that all goods mentioned on this document will be exported for humanitarian purposes only (not for sale) to above mentioned country. We further declare that the goods will not be re-imported into the EU.
Date :

Para obtener una traduccin de este catlogo, por favor solictelo a alh@farmamundi.org

Pour une traduction de ce catalogue, demandez-la alh@farmamundi.org

UNE-EN ISO 9001:2008 Quality Management System certified by IQNet and Aenor for International non profit distribution of drugs, medical devices and equipment for humanitarian aid. Non profit sanitary organisation inscribed in The National Reg. of Assoc. nr 105764,1993 -07-02. Vat nr- ES G-46973715. Recog. by the Spanish gov. as Assoc. of Public Interest, 2001-04-24.

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012

Price List 2012