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EPICA - 112bis rue Cardinet, 75017, Paris, France Tel: + 33 (0) 1 42 04 04 32 - Fax: + 33 (0) 1 45 06 02 88 - [email protected] - www.epica-awards.com EPICA is a division of MAYDREAM S.A. (capital of € 817,131) - 411 475 114 RCS Nanterre – VAT number: FR56 411 475 114 EPICA AWARDS TROPHY AND CERTIFICATE ORDER FORM Your Company Details Company: Address: City: Postal Code: Country: Your Title and Name: Email: Telephone: Mobile: VAT# (Mandatory for European Union companies): Your Order Please describe the nature of your order – If it is a Trophy or a Certificate, for what kind of Type of Award (Grand Prix, Gold, Silver, Bronze) – and specify the Year, Agency Name, Country, Category and Campaign. If it is a book please indicate the year and if it is a brand tribute, the tributed brand or agency. ITEMS QUANTITY PRICES TOTAL GRAND PRIX trophy x 450 Euros = Euros GOLD trophy x 400 Euros = Euros SILVER trophy x 200 Euros = Euros BRONZE trophy x 200 Euros = Euros CERTIFICATE (all awards) x 80 Euros = Euros EPICA BOOK x 80 Euros = Euros BRAND TRIBUTE x 40 Euros = Euros TOTAL OF YOUR ORDER Euros
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