Lastname, Name  : __________________________________________________

    Company ____________________________________________________________

    Address ____________________________________________________________
            ____________________________________________________________
    Phone   _________________________  Fax._____________________________


    JDS - Software Vertrieb
    Jens Driese                                   Fax.: +49-4451-959196
    P.O. BOX 1269                                 CIS:  100273,2252
                                                  BBS:  +49-4451-959193
    D-26302 Varel                                 CIS:  GO JDSONLINE




    Order:
    --------------------------------------------------------------------
    Qty

    ____   Atlantis V2.60 for Windows  ($30)  DM 45,00  =    _____ DM

     1     Shipping/handling overseas  ($10)  DM 15,00  =     15,- DM                      

                                                     Total   _____ DM


    Billing method

    ( ) Cash
    ( ) Creditcard (VISA/DINERS/EURO/MASTER-CARD)

    Number:_______________________ Exp.-Date:___________
    Owner :_____________________________________________
    Card  :( ) VISA   ( ) DINERS  ( ) EURO/MASTER


    Comments____________________________________________________________

            ____________________________________________________________

            ____________________________________________________________
    

                                                  ______________________
                                                         Signature