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Text File  |  1999-01-29  |  1KB  |  44 lines
  1. dblScan v1.0 for windows 95/98/NT Order Form
  2. ==================================================================
  3.                                         NUMBER OF   PRICE      TOTAL
  4. PRODUCT DESCRIPTION                     COPIES      EACH       PRICE
  5.  
  6. dblScan v1.0      (P&P incl)            ________   $15.00   $_______
  7.      
  8.  
  9. Date: ___/___/___                           TOTAL ORDER:    $_______
  10.  
  11.  
  12.                        SHIP TO:           (Please print or type)
  13.  
  14. Name: _________________________________________________
  15.  
  16. Company: ______________________________________________
  17.  
  18. Address: ______________________________________________
  19.  
  20. City, State, ZIP: _____________________________________
  21.  
  22. Country: ______________________________________________
  23.  
  24. Daytime Phone #: ______________________________________
  25.  
  26. Email Address :  ______________________________________
  27.  
  28.  
  29. Payment:  (___) Check enclosed  (___)Cash enclosed
  30.  
  31.  
  32. Signature: ________________
  33.  
  34.  
  35.  
  36. *** SEND COMPLETED FORM WITH YOUR PAYMENT TO: ***
  37.  
  38. P. de Kievit
  39. Stokroosstraat 145
  40. 2565 BL Den Haag
  41. The Netherlands
  42. email:boldy@dds.nl
  43. *************************************
  44.