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  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.  
  10.  
  11. DISK SIZE:
  12.         [  ] 3.5", 1.4MB
  13.         [  ] 5.25", 1.2MB
  14.  
  15. COST:
  16.     [  ] WinLab V3.0           ITL 120.000 (~ 80 US$)
  17.     [  ] NetProto V1.0         ITL 30.000  (~20 US$)
  18.  
  19.         [  ] I have got the shareware distribution
  20.         [  ] internet    [  ] BBS      [  ] CD-ROM    [  ] Other
  21.  
  22. SHIPPING CHARGES 
  23. (not required if you have got the shareware distribution anywhere)
  24.         [  ] Italy: ITL  8.000
  25.         [  ] All other countries: ITL  15.000 (~ 10 US$)
  26.  
  27. Total Amount         ITL _______
  28.  
  29. MAILING ADDRESS:
  30. PhD Engineering S.r.l.
  31. CorsoEuropa, 157/1 I-16132 ITALY 
  32.  
  33. PAYMENTS:
  34.  Make checks payable to "PhD Engineering S.r.l.". 
  35. or 
  36.  
  37. Check yourcard: [  ] Visa  [  ] MasterCard
  38.  
  39. Card number:__________________________Expiration date:_____/_____ (MM/YY)
  40.  
  41. Signature:___________________________________
  42.  
  43. In the case of payment by credit card please mail the form also, since original signature is required
  44.  
  45.  
  46.