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REGISTER.DOC
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1991-05-04
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1KB
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46 lines
ESaSS B.V. / Thunderbyte PC Immunizer Division
--------------------------------------------------------------------
P.O. Box 1380, 6501 BJ Nijmegen, The Netherlands, Tel. +31-80-787881
Fax. +31-80-789186
2:280/200 @fidonet
TBSCANX ORDER
___ copies TbScanX
payment in advance $ 20 each...............$________
Subtotal ..................................$________
Method of payment:
[ ] Check (send to address, mentioned above)
[ ] Money order
[ ] Euro/ Master/Visa/Access
Credit Cards (add 5% surcharge).......$________
Call: +31-80-238689
Total amount due...........................$________
Credit Card #:_______________ Expiration date __ /__
Bank account: 16 78 30 880 of Rabobank Nijmegen, the Netherlands.
Account holder: ESaSS B.V., Nijmegen.
Giro account: 37 99 158 of PostBank Nijmegen, the Netherlands.
Account holder: ESaSS B.V., Nijmegen.
State on cheque and/or money order: 'TbScanX'.
Name:__________________________________
Street+Nr.:____________________________
ZIP/District Code:_____________________
City:__________________________________
Country:_______________________________
Phone#:________________________________
*EOF*