Belgian & Dutch Order Form
This form is for bank transfers only.
There are no credit card payments possible for this concert
Fill out the blank fields in the order form below and hit
"Send order form now".
On the same day, transfer the correct amount to bankaccount #
780-5644554-40
of Thierry Limpens (Thabor vzw), Keibergstraat 14, 3000 Lierde

Mention your name, address and exact number of tickets on your transfer as well.
First & Last Name:
Address & Nr:
Postal Code:
Town:
Phone Number:
Email:
Check the box and enter the number
of tickets you would like to order.
CONCERT TICKET:
Words & Music
July 2nd 2005		 Quantity:  x 15.00 EUR
Comments:
Your ticket will be available at the ticket booth.
Limited offers - as long as supply lasts.
Once we receive your payment, we'll confirm your order.
ATTENTION:
The pre-sales is held by the organiser of the concert, Thierry Limpens of Thabor vzw.
Call them directly in case of any questions or for further info:
+32 497 17 52 09