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Text File  |  2001-03-01  |  2KB  |  50 lines
  1. Full Name:
  2.                  ---------------------------------
  3. Contact person:
  4.                  ---------------------------------
  5. Street:
  6.                  ---------------------------------
  7. Zip, City:
  8.                  ---------------------------------
  9. Country:
  10.                  ---------------------------------
  11. E-Mail or Fax: 
  12.                  ---------------------------------
  13.  
  14.  
  15.     Star-Tools GmbH                    +----------------------+
  16.     - Sales -                          ! Fax: +49 40 52950607 !
  17.     Hopfenweg 207                      +----------------------+
  18.     22851 Norderstedt
  19.     Deutschland
  20.  
  21.  
  22. O R D E R :
  23.  
  24.     Licence(s) Bootmanager BOOTSTAR each US$ 20.00  US$     .00
  25. ---  (Please fill in the number of systems)
  26.  
  27. ( ) Registration Key, Invoice via E-Mail US$  0.00  US$     .00
  28. ( ) Registration Key, Invoice via Fax    US$  5.00  US$     .00
  29. ( ) Disk, Invoice via postal mail        US$ 10.00  US$     .00
  30.                                                     -----------
  31.       Total                                         US$     .00
  32.                                                     ===========
  33. Payment Options:
  34.  
  35. ( ) Cash (not a draft) in advance
  36.                                    ----------------------------
  37. ( ) VISA                            Card owner
  38.  
  39. ( ) Euro-/MasterCard
  40.                                    ----------------------------
  41. ( ) American Express                Card number
  42.  
  43. ( ) After receiving Invoice
  44.     (only to companies, min.       ----------------------------
  45.      of US$ 100.00, shipping        Expire date
  46.      only via postal mail)
  47.  
  48.  
  49.                      ----------    ----------------------------
  50.                       Date          Signature (Card owner)