        Order Form
                                  EasyFractal (Shareware)

This is to confirm that I would like to become a registered user of EasyFractal. The shareware fee within Europe amounts to 40 DM and 20 USD in the USA and other countries. I will pay this fee as indicated below.
As a registered user of this software, I will be notified by Email about upcoming new versions of this program, which I then may download free of charge from the Internet. My contribution also supports the further development of EasyFractal.

Please print out this form, fill it out, and send it via postal mail to:
   Berkhan-Software
   Alt-Isenhagen 19
   D-29386 Hankensbuettel
   Germany

or fax the form to:  ++49  5832 / 6160

Of course, you may also register by Email by sending the required information to:                     
                info@berkhan.de       Subject: EasyFractal
or on our wedsite at http://www.berkhan.de/best6_e.htm

After your payment has been received, you will be send your registration number immediately, either via fax, Email, or postal mail. 


First and Last Name: ___________________________________________________

Street:                      ___________________________________________________

City, State, ZIP:        ___________________________________________________

Country:                    ___________________________________________________

Email:                       ___________________________________________________

Telephone / Fax:       ___________________________________________________





Payment Options:   

Credit Card:  Card No.:           _______________________________________________

                     Expiration Date: _______________________________________________  

                     Name on Card:    _______________________________________________


Check:          Non-Negotiable Check / Euro Check is enclosed.



____________________________________________________________________
City, Date, Signature




