description of material

weight  in
grams or Oz

reference 
price/g

Dental alloys

Fine metal 999,9 signed

Coins / Gold

Coins / Silver

old or broken gold

dental gold evenwith teeth

precious metal as:

date of reference price at Aurum and received ID

ID:

Name of sender

Country:

Street and Number

Zip Code City

Please choose  "Ordercheck" or  "Direct Remittance"

Aurum will send your Ordercheck to adress above  click it,  if you prefer the check.

For an innereuropean direct remittance,  we need your correct IBAN and BIC/SWIFT Codes.
Please ask your bank for your correct codes.

Direct Remittance to my account in :
(country)   

IBAN:

BIC/SWIFT:

Owner of account:

If nessessary, how can we get contact to you? Please fill in:
Phone or Fax or Mail

AURUM: Tel. 0049- 40 / 5544698 - 0   FAX: 0049 - 40/ 55 44 6982

 
Email Aurum for questions before sending: info@aurum-edelmetalle.com

Please sign this form by hand.    After filling it, please put it in your package or envelope

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