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Text File
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1995-05-14
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1KB
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43 lines
Send to:
PD Profi Zoettlein GmbH Phone: +49-8432-1296
Schulstr. 13 Fax: +49-8432-8674
86666 Burgheim CIS: 100326,53
Germany
Name:_______________________________________________________________
Address:____________________________________________________________
City:___________________________________ State:______ ZIP:__________
Country:____________________________________________________________
Phone:_____________________________ Fax:____________________________
EMail:_____________________________
YES! I would like to purchase my personal registration number
for Dave Dude 95, Release 2:
Registration# for Dave Dude 95, Release 2................. DM 39,-
Shipping and handling (Europeen Community)................ DM 10,-
Total: DM 49,-
I pay by [ ] eurocheque(included) or
[ ] VISA or [ ] MasterCard or [ ] AmEx
Card#(16 digits):__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date: __ __ / __ __ Cardholders name: __________________
Cardholders Signature: ____________________________________________
Date:__________________________ Signature:_________________________