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Text File  |  2004-11-30  |  2KB  |  51 lines
  1. order form for Security Task Manager            program ID: 174510
  2.  
  3. Order your registration code for $29 (EUR 29) from our
  4. distributor ShareIt with this form or online at www.neuber.com
  5.  
  6. Fill out and print this form and mail or fax it to:
  7.  
  8. share-it!                      <- or ->                   ShareIt!
  9. 9625 West 76th Street, Suite 150                       element5 AG
  10. Eden Prairie, MN 55344                         Vogelsanger Str. 78
  11. U.S.A.                                                D-50823 K÷ln
  12.                                                            Germany
  13.                                              
  14. phone: +1-800-903-4152                            +49-221-31088-20
  15. fax:   +1.952.646.4552                            +49-221-31088-29
  16.                                                support@shareit.com
  17.  
  18.     Name : ______________________________________
  19.  
  20.  Company : ______________________________________
  21.  
  22.   Street : ______________________________________
  23.  
  24.     City : ______________________ State : _______
  25.  
  26.  Country : _____________________ ZIP/PC : _______
  27.  
  28.    Phone : ______________________________________
  29.  
  30.      Fax : ______________________________________
  31.  
  32.    Email : ______________________________________(important)
  33.  
  34. Shipping the registration code 
  35. [ ] via email (recommended)
  36. [ ] via fax
  37. [ ] via postal mail
  38.  
  39. Method of payment
  40. [ ] bank/wire transfer
  41. [ ] check
  42. [ ] cash
  43. [ ] credit card               name on card: ______________________
  44.     [] Mastercard
  45.     [] VISA              card number:  ______________________
  46.     [] American Express
  47.     [] Diners Club          exp. date:    ______________________
  48.  
  49.  
  50.  
  51. Date / Signature: ___________________________________