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ORDER.FRM
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1996-09-15
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Order Form for SPLOT - The Pen Plotter Simulator (MS-DOS version)
Your Name: _____________________________________________________________
Company: _______________________________________________________________
Address: _______________________________________________________________
City: _____________________________ Prov/State: _____________________
Country: _____________________________ ZIP/Postal: _____________________
E-mail: ______________________________ Tel./Fax:________________________
If you are registered user already, your serial number: ________________
Licence: [ ] single user [ ] multisystem site
Payment: [ ] Cash (money enclosed)
[ ] Credit card (fill out credit card information below)
[ ] Bank or travelers cheque (payable in US funds)
[ ] Send me an invoice first
I'd like to order the SPLOT program for the following plotter type(s):
[ ] HP 7470A ............................................ ___________ US$
[ ] HP 7475A ........................................... ____________ US$
[ ] HP 7440A ColorPro .................................. ____________ US$
[ ] HP 7550A ........................................... ____________ US$
[ ] HP DraftPro ........................................ ____________ US$
[ ] HP DraftMaster ..................................... ____________ US$
[ ] Roland GRX 300/400 ................................. ____________ US$
[ ] Roland DXY ......................................... ____________ US$
Shipping (Outside Europe) .............................. ____________ US$
TOTAL AMOUNT ( US dollars ) ............................ ____________ US$
I hereby authorize the above amount to be charged to my
[ ] MasterCard [ ] VISA [ ] American Express
Name as it appears on card:__________________________________________
Credit card number:_______________________ Expiration date:__________
Signature:_________________________________
Your comments: ________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
(add any additional comments you wish separately)
Mail this form to: Alexandr Novy
Havlickova 2209
390 01 TABOR
Czech Republic