--------------------------------- | O R D E R - F O R M M S C A N | --------------------------------- Yes! I would like to order MSCAN. Please send by airmail the latest and integral version of this program, including the printed manual, to: Name : ___________________________________________________________________ Address : ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Country : ___________________________________________________________________ Callsign: _ _ _ _ _ _ (please provide a personalized callsign if you want to use the transmit option, do not use general calls like 'mscan', 'sstv', 'color' etc.) Tel: __________________ Fax: __________________ Email: __________________ Send me a.s.a.p. (tick your choice): [ ] MSCAN 2.10 . . . . . . . . . . . . . . . . . . . . . . fl. 95 (US$ 59) [ ] MSCAN 2.10 UPGRADE . . . . . . . . . . . . . . . . . . fl. 50 (US$ 31) (if you already have a registered version of MSCAN) [ ] Microscan 1.3 (256 colour version) . . . . . . . . . . fl. 50 (US$ 31) [ ] Microscan RX interface . . . . . . . . . . . . . . . . fl. 75 (US$ 47) [ ] Miniscan interface . . . . . . . . . . . . . . . . . . fl. 149 (US$ 93) [ ] Multiscan RX pcb . . . . . . . . . . . . . . . . . . . fl. 39 (US$ 24) [ ] Multiscan TX pcb . . . . . . . . . . . . . . . . . . . fl. 30 (US$ 19) (order both for TRX) [ ] Multiscan RX kit of parts . . . . . . . . . . . . . . fl. 120 (US$ 75) [ ] Multiscan TX kit of parts . . . . . . . . . . . . . . fl. 75 (US$ 47) (order both for TRX) [ ] Aluminum eurocase for kit or pcb . . . . . . . . . . . fl. 39 (US$ 24) [ ] Multiscan RX assembled . . . . . . . . . . . . . . . . fl. 299 (US$ 187) [ ] Multiscan TRX assembled . . . . . . . . . . . . . . . fl. 450 (US$ 281) [ ] Video Blaster SE100 video digitizer . . . . . . . . . fl. 549 (US$ 343) [ ] Iris high resolution video digitizer . . . . . . . . . fl. 945 (US$ 591) [ ] SVGA graphics card true colour (VLB or PCI) . . . . . fl. 215 (US$ 134) [ ] Serial mouse 3-buttons . . . . . . . . . . . . . . . . fl. 39 (US$ 24) More information about our products is available on request and can be found on our web site. If you live in Denmark, Hungary or the United Kingdom then you should order any hardware through your local MSCAN agent (see manual). We also sell supplies (cables, switch boxes, gender changers etc.) and electronic parts. I will pay as follows: [ ] I have included cash (any currency will do) [ ] I will pay with a Postal money order (also send us this form!) [ ] I have included a EUROcheque made out in Dutch guilders (fl.) [ ] I will pay (+5%) by [ ] Mastercard/Eurocard, [ ] VISA or [ ] JCB Card number : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiry date (good thru): _ _ / _ _ Owner's name : _______________________________________________ Owner's street address : _______________________________________________ Owner's postal/zip code: _______________________________________________ Owner's signature : _______________________________________________ [ ] I have included a cheque (personal or cashiers) and will pay fl. 15.- (US$ 9) extra for the costs [ ] I have transferred the amount to [ ] Postbank Arnhem PSTBNL2A nr. 1747205 or [ ] Rabobank Rockanje nr. 35.57.02.606 for CombiTech in Rockanje and will pay fl. 15.- (US$ 9) extra for the costs (also send us this form!) All orders are sent via airmail and free of charge! (E)Mail or fax this form to: CombiTech, P.O. Box 507, 3235 ZG Rockanje, Holland. Tel/Fax: +31 181 404252 B.B.S. : +31 181 404513 Email : combitech@pi.net http://www.pi.net/~ctech ---------------------------------- | Thank you for your registration! | ----------------------------------