home *** CD-ROM | disk | FTP | other *** search
/ C!T ROM 5 / ctrom5b.zip / ctrom5b / DOS / UTILITY / DIVERSEN / AGSI100E / ORDERFRM.TXT < prev    next >
Text File  |  1994-12-18  |  2KB  |  53 lines
  1.  
  2.                        Order Form for agSI Version 1.0
  3.                      ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
  4.  
  5.  
  6.         (please fill in / check:)
  7.  
  8.                                               prices each    prices total
  9.  
  10.         ___ x Licence for agSI              DM 20,- / $ 15 ->  __ _____
  11.               (you will recieve a registration code)           ^ currency
  12.  
  13.         ___ x Disk with latest version      DM  5,- / $  4 ->  __ _____
  14.               (default 3 1/2 ")
  15.               [ ] I want 5 1/4 " disk(s)
  16.  
  17.         Ask for discounts on quantity orders!
  18.  
  19.         Payment/Shipping:
  20.         ( )   pre-paid (cash / cheque)                             --
  21.         ( )   C.O.D. (only inside Germany!)       DM  5,-  ->  __ _____
  22.         (No credit card orders as I have no way to handle them.)
  23.  
  24.                                                             =============
  25.  
  26.         Total:  -------------------------------------------->  __ _____
  27.  
  28.         [ ]  Please inform me about "major" upgrades...
  29.              [ ] via e-mail     [ ] via letter
  30.  
  31.  
  32.         Name:    ____________________________________________________
  33.  
  34.         Company: ____________________________________________________
  35.  
  36.         Address: ____________________________________________________
  37.  
  38.                  ____________________________________________________
  39.  
  40.                  ____________________________________________________
  41.  
  42.         E-Mail:  ____________________________________________________
  43.         (accessible from the Internet)
  44.  
  45.  
  46.         Date: ________________   Signature: _________________________
  47.  
  48.  
  49.         Mail to:  Andreas Grögel,  Gildenstr. 4,
  50.                   D-74074 Heilbronn,  Germany
  51.         or (C.O.D. delivery) via e-mail (Internet) to:
  52.                          ag@studbox.uni-stuttgart.de
  53.