V.I.P. form

Café-couette's V.I.P. service FOR LIFE request form

Print this form and fill it, before to post it with your payment, to the following address:

Café-Couette.com
Subscription service
1835 Holy Cross
Montréal, Québec
Canada, H4E 2A3

You user number: (The numbers at the beginning of your user name)

The name of your Bed & Breakfast:

Your full name:

Your street address:

Town:

Province / State:

Country:

Postal code:

Phone number:

Please join your payment to this form (We now accept personal check in Canadian dollars, in Euros, and in U.S. dollars) addressed to: IMAGE-I-NATIF, using one of these three following option:

- Make your payment for the amount of 57$ Cad. (This amount includes Canada's taxes).
or:
- Make your payment in US funds for the amount of 60$ Usd, (This amount includes processing fee for personal check in currency other than Canadian dollars)
or:
- Make your payment for the amount of 45 Euros (€). (This amount includes processing fee for personal check in currency other than Canadian dollars)

(Any payment in any other fund then Canadian, American or Euros, will be refused, and will not be cashed, neither will it be returned to the sender. It will just be destroyed.)

V.I.P. service will be activated after the reception of your payment (please allow a delay from 1 to 2 weeks).

If you are sending us your photos with the order, and want these to be returned to you, please include a return envelope with your address written on it. Take note that we cannot be held responsible for any loss in the postal system.

You user number: (The numbers at the beginning of your user name)
The name of your Bed & Breakfast:
Your full name:
Your street address:
Town:
Province / State:
Country:
Postal code:
Phone number: