Essens - Centre for Well-Being and Expansion of Consciousness

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		Order your gift voucher

	Call [+32] 475 350 133 or complete the form below and mail it to info@essens.be. As soon as we receive your order, we will send you an email to confirm, including the order transfer number for payment. The gift voucher will be sent by normal mail to you as soon as we have received your payment or you can come and collect it yourself at Essens.

		Order

First name *
Name *
Address *
Zip *
City *
Tel *
Mobile
Email *

I want to receive an invoice:		yes		no

If you want to receive an invoice, please complete the following information:
Company
VAT
Billing address	Same as above
	Other (please complete full address)

Address
Zip & city

Herewith I order	Number
gift vouchers at 25 €
gift vouchers at 45 €
gift vouchers at 55 €

Message on gift voucher:

I will collect the vouchers at Essens:
Please send the vouchers:	to the same address as above
	to the following address

Name & first name
Address
Zip & city


Message to Essens related to this order

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