software ORDER FORM AND FAX SHEET 
                   (Fax Number:+39-10-357271) 
                  or e-mail to dede@dibe.unige.it

Name (Please Print) _______________________________________________________
Address____________________________________________________________________
City________________________State/Province___________________ZIP___________
Country_____________________Phone/Fax______________________________________
e-mail_______________________________________Date__________________________


DISK SIZE:
        [  ] 3.5", 1.4MB
        [  ] 5.25", 1.2MB

COST:
	[  ] WinLab V3.0           80 US$
	[  ] NetProto V1.0         20 US$
	[  ] TWAIN support V1.0    10 US$

        [  ] I have got the shareware distribution
        [  ] internet    [  ] BBS      [  ] CD-ROM    [  ] Other

SHIPPING CHARGES 
(not required if you have got the shareware distribution anywhere)
        [  ] Italy: 7 US$
        [  ] All other countries: 10 US$

Total Amount 		US$ ______

MAILING ADDRESS:
PhD Engineering S.r.l.
CorsoEuropa, 157/1 I-16132 ITALY 

PAYMENTS:
 Make checks payable to "PhD Engineering S.r.l.". 
or 

Check yourcard: [  ] Visa  [  ] MasterCard

Card number:__________________________Expiration date:_____/_____ (MM/YY)

Signature:___________________________________

For payment by credit card please mail the original form, since original signature is required