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Text File  |  1996-02-13  |  1KB  |  48 lines
  1.                  software ORDER FORM AND FAX SHEET 
  2.                    (Fax Number:+39-10-357271) 
  3.                   or e-mail to dede@dibe.unige.it
  4.  
  5. Name (Please Print) _______________________________________________________
  6. Address____________________________________________________________________
  7. City________________________State/Province___________________ZIP___________
  8. Country_____________________Phone/Fax______________________________________
  9. e-mail_______________________________________Date__________________________
  10.  
  11.  
  12. DISK SIZE:
  13.         [  ] 3.5", 1.4MB
  14.         [  ] 5.25", 1.2MB
  15.  
  16. COST:
  17.     [  ] WinLab V3.0           80 US$
  18.     [  ] NetProto V1.0         20 US$
  19.     [  ] TWAIN support V1.0    10 US$
  20.  
  21.         [  ] I have got the shareware distribution
  22.         [  ] internet    [  ] BBS      [  ] CD-ROM    [  ] Other
  23.  
  24. SHIPPING CHARGES 
  25. (not required if you have got the shareware distribution anywhere)
  26.         [  ] Italy: 7 US$
  27.         [  ] All other countries: 10 US$
  28.  
  29. Total Amount         US$ ______
  30.  
  31. MAILING ADDRESS:
  32. PhD Engineering S.r.l.
  33. CorsoEuropa, 157/1 I-16132 ITALY 
  34.  
  35. PAYMENTS:
  36.  Make checks payable to "PhD Engineering S.r.l.". 
  37. or 
  38.  
  39. Check yourcard: [  ] Visa  [  ] MasterCard
  40.  
  41. Card number:__________________________Expiration date:_____/_____ (MM/YY)
  42.  
  43. Signature:___________________________________
  44.  
  45. For payment by credit card please mail the original form, since original signature is required
  46.  
  47.  
  48.