boleto .pdf

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Original filename: boleto.pdf
Title: Microsoft Word - boleto
Author: LoCo

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CIÊNCIA RURAL
REVISTA CIENTÍFICA DO CENTRO DE CIÊNCIAS RURAIS - UFSM
CENTRO DE CIÊNCIAS RURAIS, PRÉDIO 42, SALA 3104
97105-900 - SANTA MARIA, RS - BRASIL
FONE: xx(55) 32208698
FAX: xx(55) 32208695
Email: cienciarural@mail.ufsm.br
homepage: http//www.ufsm.br/ccr/revista/
Formulário para pagamento de taxa de publicação / por solicitação de fatura /pro form
invoice/ paper fees.

Nome (name) pessoa física/jurídica:…………………….………………………………...……………………….
…………………………………………………………………………………………………………………..……………………….
CPF:……………………………………………………………………………………………………………..…………………….
Carteira de identidade:………………………………………………………………………………...……………………
CNPJ (quando pessoa jurídica):…………………………………………………………………..…….………………
Endereço completo: …………………………………….…………………………………………………………..……….
…………………………………………………………………………………………………………………………………...……….
Telefone:.............................................................Fax:.........................................
N°:……………..Complemento:…………………………………Bairro:…………………..CEP:………….…………
Cidade:……………………………………………………Estado………………………………………………………...…….
E – mail:………………………………………………………………………………………………………………………….....
Data (Date):......./........./........
Assinatura/Signature:...........................................................................................
Título do artigo:...................................................................................................
.........................................................................................................................

Obs.: envie este formulário por correio, fax ou e-mail. / please return the document
by fax/ regular mail/e-mail.


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