Payment by credit card for shareware "EpsonShare" ------------------------------------------------------------------------------------ Postal courier | Fax | Send this form to: | Send this form to: S.E.S | 1, rue de stockholm | From France: 02 31 14 90 18 75008. Paris | From Foreign: +33 2 3114 9018 FRANCE | ------------------------------------------------------------------------------------ Pricing SPECIAL OFFER UNTIL 04/30/1999 The server price varies by the number of clients you want to serve. Number French of Clients Francs Euros $USD 1 115 18 19 3 185 27 29 5 235 37 39 10 350 56 59 20 475 75 79 50 595 94 99 ------------------------------------------------------------------------------------ Your order Currency If you reside in France, thank you to pay in French Francs. Euros only for countries of the European community. Dollars US for all other countries. Clients Product Price and Currency ... EpsonShare .................. Total .................. ------------------------------------------------------------------------------------ Your name: ............................................... Your e-mail: ............................................... Address: ............................................... ............................................... City/Etat: ............................................... Postal Code/Zip: ..................../.......................... Country: ............................................... Fax number: ............................................... Credit card type (Visa,American Express ou Eurocard/Mastercard): ............................................... Your credit card number: ................................... Expiry date: ................................... ------------------------------------------------------------------------------------ Authorization I authorize S.E.S to charge my credit card for (Amount and Currency) ...................................... signature: ------------------------------------------------------------------------------------