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Text File  |  2000-02-02  |  2KB  |  77 lines
  1. Order form for GSound 22 CD-ROM + Mellosoftron key
  2. ==================================================
  3.  
  4. Program number: 102680
  5.  
  6. Price: $49
  7.  
  8. Last name: __________________________________________________________
  9.  
  10. First name: _________________________________________________________
  11.  
  12. Company: ____________________________________________________________
  13.  
  14. Street and number: __________________________________________________
  15.  
  16. City: _______________________________________________________________
  17.  
  18. State: ______________________________________________________________
  19.  
  20. Postal code: ________________________________________________________
  21.  
  22. Country: ____________________________________________________________
  23.  
  24. Phone: ______________________________________________________________
  25.  
  26. Fax: ________________________________________________________________
  27.  
  28. E-Mail: _____________________________________________________________
  29.  
  30.  
  31. The GSound 22 CD-ROM will be sent to you by postal mail. How would 
  32. you like to receive your Mellosoftron key?
  33.  
  34. [ ] By e-mail
  35. [ ] By postal mail
  36.  
  37. Payment method:
  38.  
  39. [ ] Credit card
  40. [ ] Bank wire
  41. [ ] EuroCheque (DM-denominated only - send to European address)
  42. [ ] US check (send to US address)
  43. [ ] Cash (US dollars)
  44.  
  45. ---
  46.  
  47. If you select "Bank wire", your order will be 
  48. processed when the payment is received at the 
  49. following account:
  50.  
  51. Account holder: element 5 AG
  52. Bank:           Postbank Koeln, Germany
  53. Bank number:    370 100 50
  54. Account number: 692 77-506
  55.  
  56. ---
  57.  
  58. Credit card information (if applicable)
  59.  
  60. Credit card: 
  61.  
  62. [ ] Visa
  63. [ ] Mastercard / Eurocard
  64. [ ] American Express
  65. [ ] Diners Club
  66.  
  67. Card holder: ________________________________________________________
  68.  
  69. Card number: ________________________________________________________
  70.  
  71. Date of Expiration : ________________________________________________
  72.  
  73. ---
  74.  
  75. Date / Signature ____________________________________________________
  76.  
  77.