Akiko order form

Name:      _______________________________________________

Address:   _______________________________________________

Address 2: _______________________________________________

Zip code:  __________ Town: ______________________________

Phone:     _______________________________________________

E-Mail:    _______________________________________________

Homepage:  _______________________________________________

I would like the full version shipped

( ) by e-mail
( ) by mail (please attach 2 USD/2 EUR for postage)

Please send me the full version of Akiko. The registration
fee of 15 USD/15 EUR is enclosed with this mail

( ) as cash
( ) as a check (checks can be only accepted from Europe!)
( ) as a postal money order



Date: _____________ Signature: __________________________

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Print this form and mail it together with the payment to:

Andreas Falkenhahn
An der Trift 2
36132 Eiterfeld-Arzell
GERMANY


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