The European Equipment Rental Industry
Report 2014

Order Form

Step 1 – Delivery Address:

First Name
Last Name
Organisation Name
Address
Postcode - City
Country
E-mail Address
Main Phone
Fax
VAT number

Step 2 – Billing address (if different from above):

First Name
Last Name
Organisation Name
Address
Postcode - City
Country
E-mail Address
Main Phone
Fax
VAT number

Step 3 – Your Order:

The price of the report differs depending on whether you are a member of the ERA or not.

Item / Quantity / Price per Item / Total (EUR)
Member of ERA / 300 EUR
Non-Member of ERA / 900 EUR
GRAND TOTAL (EUR)

All prices are excluding Belgian VAT.[1]

Step 4(a) – Payment by Credit Card

Total Amount
Card (please tick)[2] / VISA / MasterCard / AMEX
Cardholder’s First and Last Name
Card number
Expiration date
Card Verification Code
(last three digits at back of VISA and MasterCard, last four digits at front of AMEX cards)
Signature(Please sign by hand)

Step 4(b) – Payment by Bank Transfer

To pay by bank transfer, please attach a proof of payment with your fax. An invoice will be sent to you once payment is received.

Please remit payment to:

Account Holder: European Rental Association
Bank:
BNP Paribas Fortis Bank
Montagne du Parc 3,
B-1000 Brussels
Acct. No.: 001-4829581-27
IBAN : BE48 0014 8295 8127
SWIFT/BIC : GEBABEBB

Communication: ERA Stats Report 2014

Please fax this form fully completed, to +32 2 761 1699

Should you have questions please
call: 0032 (0)2 761 1604 or email:

[1]1) In accordance to Belgian Distance Selling Law, you are able to cancel within 7 working days of your order being received, otherwise the transaction stands.

[2]) Card will be charged by Kellen Europe NV, on behalf of the European Rental Association AISBL.