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  1. 44508A5A
  2. Contact Bugfix by phone 0800-328-4157 or WEB SITE http://www.bugfix.co.uk 
  3. Email: sales@bugfix.co.uk or press F3 to print a FAX order form.
  4. [start]
  5.                       2000 Check FAX ORDER APPLICATION.
  6.                       *********************************
  7.  
  8. Please complete the following in full and Fax to: 01722-322-198
  9.  
  10. Please supply a key code for the following Computer ID Number and deliver
  11. that code by (delete as apropriate) Fax/Post/E-Mail
  12. Post To: Bugfix,P.O. Box 1725, Salisbury, SP1 2UL 
  13. Computer ID Number = 0003 
  14.  
  15.                               DELIVERY DETAILS:
  16.                               ****************
  17.  
  18. Mr/Mrs/Ms:   First Name:................... Last Name:....................
  19.  
  20. Address 1:............................................
  21.  
  22. Address 2:............................................
  23.  
  24. City:.................................................
  25.  
  26. State/Province:....................   Zip/Postal Code:....................
  27.  
  28. Country:....................
  29.  
  30. Telehone:...............    Fax:...............    E-Mail:...............
  31.  
  32.  
  33.                  CARDHOLDER ADDRESS IF DIFFERENT FROM ABOVE:
  34.                  *******************************************
  35.  
  36. Mr/Mrs/Ms:   First Name:................... Last Name:....................
  37.  
  38. Address 1:............................................
  39.  
  40. Address 2:............................................
  41.  
  42. City:.................................................
  43.  
  44. State/Province:.....................  Zip/Postal Code:....................
  45.  
  46. Country:....................
  47.  
  48.  
  49.                               PAYMENT DETAILS:
  50.                               ****************
  51.  
  52. Credit card type:...................... Credit Card Number:...............
  53.  
  54. Name on Card:.......................... Expiry Date (mm/yy):..............
  55.  
  56.  
  57. I authorise you to debit รบ19.99 from the above credit card.
  58.  
  59. Signature:.............................
  60.  
  61.