Order-Form

PmaSoft
Mario Prem
Reichendorf 140
8212 Pischelsdorf
Austria

Telefax 0049 (0)1212-5-832-59-784
Telephone 0043 (0)664-325-9652
eMail: office@pmasoft.net

Order from:

Name:                  	________________________
Company:	               	________________________
PLZ, Adress:             	________________________  
Telephon:               	________________________
Email:	               	________________________ !!! Important !!!

Title	Product	Items	Price	Sum	
 OnlineEye Pro	p Single User 		15,00 Euro  	  	
	p Family Licence 		29,95 Euro  		
	p Small Company 		69,95 Euro 		
	p Organization		500,00Euro		

How would you like to pay the registration fee:

[  ]  Cash - Send the amount by mail to our Post Box
	
[  ]  Creditcard

	WEB: http://www.pmasoft.net

[  ]  Wiretransfer
            
Raiffeisen-Bank Pischelsdorf - AUSTRIA
Mario Prem
IBAN: AT243828500000108779
BIC:   RZSTAT2G285

Date: _____________ Sign: _____________________________