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Text File  |  1991-04-09  |  1.3 KB  |  46 lines
  1. ESaSS B.V. / Thunderbyte PC Immunizer Division
  2. --------------------------------------------------------------------
  3. P.O. Box 1380, 6501 BJ Nijmegen, The Netherlands, Tel. +31-80-787881
  4.                                                   Fax. +31-80-789186
  5.  
  6. 2:280/200 @fidonet
  7.  
  8.  
  9.                         TBSCANX ORDER
  10.  
  11.  
  12. ___ copies TbScanX
  13.  
  14.     payment in advance $ 20 each...............$________
  15.  
  16.     Subtotal ..................................$________
  17.  
  18.     Method of payment:
  19.     [  ] Check (send to address, mentioned above)
  20.     [  ] Money order
  21.     [  ] Euro/ Master/Visa/Access
  22.          Credit Cards (add 5% surcharge).......$________
  23.          Call: +31-80-238689
  24.  
  25.     Total amount due...........................$________
  26.  
  27.     Credit Card #:_______________   Expiration date __ /__
  28.  
  29. Bank account: 16 78 30 880 of Rabobank Nijmegen, the Netherlands.
  30. Account holder: ESaSS B.V., Nijmegen.
  31.  
  32. Giro account: 37 99 158 of PostBank Nijmegen, the Netherlands.
  33. Account holder: ESaSS B.V., Nijmegen.
  34.  
  35. State on cheque and/or money order: 'TbScanX'.
  36.  
  37. Name:__________________________________
  38. Street+Nr.:____________________________
  39. ZIP/District Code:_____________________
  40. City:__________________________________
  41. Country:_______________________________
  42. Phone#:________________________________
  43.  
  44.  
  45. *EOF*
  46.