Ancient Software/BMT Micro Order Form http://www.ancientsoft.com ****PLEASE PRINT CLEARLY**** If ordering by mail, please post this form to: BMT Micro PO Box 15016 Wilmington, NC 28408 U.S.A. If ordering by fax, please fax this form to: (910) 792-1889 24 hours / 7 Days ORDERING BY CREDIT CARD: We accept Visa, Mastercard, Discover, American Express, Diners ORDERING BY CHECK: Make all checks payable to BMT MICRO and write FOR DEPOSIT ONLY on the reverse side of the check for your protection. In the lower left edge of your check, please write the name of the game you are buying. Please be sure US checks are in US Dollars, Canadian checks are in Canadian funds, Euro checks are in Euros, etc, etc. ORDERING BY MONEY ORDER: Please make money orders payable in US Dollar funds, and please make money orders payable to "BMT Micro". If you reside in a country with an unconvertible currency please contact us for alternatives. Check Products Price -------------- ----- [ ] Pharaohs' Treasure ($19.95) [ ] Pharaohs' Curse Gold ($19.95) [ ] Brickanoid ($14.95) [ ] MFader ActiveX control ($79.95) [ ] Num2Alpha ActiveX DLL ($49.95) [ ] CD-ROM shipping ($10.00) (all games checked will come on one CD-ROM. Shipping is included in the $10.00 fee, no matter what country US Priority Mail) Subtotal $ _______ NORTH CAROLINA RESIDENTS ONLY add 6.5% Sales Tax $ _______ Total: $ _______ Name:________________________________________________________________ Address:_____________________________________________________________ _____________________________________________________________ City: _______________________________State/Province: ________________ Postal/ZIP Code: ____________________Country:________________________ Phone:_______________________________________________________________ Fax: _______________________________________________________________ E-Mail #1____________________________________________________________ E-Mail #2____________________________________________________________ FOR CREDIT CARD PAYMENT ONLY Circle one: VISA / Master / Discover / American Express / Diners Credit card number: _____________________________________________ Expiration date: ________________________________________________ Authorization signature: ________________________________________ ORDERING FROM INSIDE GERMANY ONLY ================================= Persons in Germany wishing to order shareware may also transfer funds into our account with Deutsche Bank. Once the money is deposited you may either fax a confirmation to us with proof of deposit or wait until Deutsche Bank notifies us of the transaction (usually 10-18 business days). Account information is as follows: Deutsche Bank / Frankfurt Branch Empf„nger: Thomas Bradford Konto-Nummer: 0860221 Bankleitzahl: 500-700-10 When you make the transfer, be sure to put your name and the program you are registering on the transfer. Current exchange rates can be obtained by sending an email to dm_to_us@bmtmicro.com. An automated reply will return todays exchange rates. It is very important that you send us a completed order form by either email or fax if you deposit money into this account for a registration. Fill the order form out as usual except in the credit card number field put "DEUTSCHE BANK". We will file the order and use it to match against the deposit information we receive from the bank. IMPORTANT! ---------- If you are concerned that your order is taking too long to process, feel free to check with us about the status of your order at orders@bmtmicro.com It's important to all of us that you feel safe doing business with our company and please feel free to suggest ways we can improve our service to you.