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Request for the teaching kit

I am ordering “Bintou and Valentin” (available in French only)

First and Last name : ____________________________________________

Agency : _____________________________________________________

Adress: ______________________________________________________
____________________________________________________________
____________________________________________________________

Email: _______________________________________________________

Mailing Address: _______________________________________________
____________________________________________________________
____________________________________________________________

Number of Kits _________
Price per Unit 15 €
Shipping Costs 5€
TOTAL _________

Date, Place and Signature

Send to: Eau Vive, 4 rue Victor Beausse, 93100 Montreuil, France

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In accordance with the law of January 6, 1978, the information requested is necessary to fulfill your order and will be kept for the exclusive use of Eau Vive. By writing to our headquarters, you can request that this information be modified or deleted.