-----------------------------------------
                  | O R D E R - F O R M   M I C R O S C A N |
                   -----------------------------------------

Yes! I would like to order Microscan. Please send to me by airmail the latest 
and integral version of this program, including the printed manual, to: 

Name    :  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address :  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

           . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

           . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Country :  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Callsign:  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(please provide a personalized callsign if you want to use the transmit 
option, do not use general calls like 'mscan', 'sstv', 'color' etc.) 

Send me a.s.a.p. (tick your choice):

[ ]  Microscan 2.01 for fl. 95.- (US$ 60)

[ ]  Microscan 1.3 for fl. 50.- (US$ 30)

[ ]  Microscan RX interface for fl. 95.- (US$ 60)

I already have a registered version of Microscan and would like to: 

[ ]  upgrade to Microscan 2.01 for fl. 50.- (US$ 30)

I will pay as follows:

[ ]  I have included cash (any currency will do)

[ ]  I have included a Post Office money order made out in Dutch guilders 

[ ]  I have included a EUROcheque made out in Dutch guilders

[ ]  I will pay by Mastercard/Eurocard (not VISA!), the full information on 
     the card is:

     card number:  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

     expiry date:  . . / . .   name: . . . . . . . . . . . . . . . . . . . . .

     address    :  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

                   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


     Signature  :  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[ ]  I have transferred the amount to Postbank Arnhem PSTBNL2A nr. 1747205 or 
     Rabobank Rockanje nr. 35.57.02.606 for CombiTech in Rockanje and will pay 
     fl. 15.- (US$ 10) extra for the costs 

[ ]  I have included a cheque from my bank and will pay fl. 15.- (US$ 10) 
     extra for the costs 

(fl. is Dutch guilders)

Mail, fax or netmail this form to:

CombiTech                       Tel/Fax: +31 18 14 42 52
Morelstraat 60                  (after 11-95: +31 181 40 42 52)
3235 EL  Rockanje               Fidonet: 2:2802/238.2 
The Netherlands                 Technet: 111:314/206.2
                                Hamnet : 12:300/118.2