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Text File  |  1990-11-05  |  4KB  |  120 lines
  1.  
  2.  
  3. Bremin & Co AB                       Order Form 901105 (credit cards)
  4. ---------------------------------------------------------------------
  5. Mail address:                              Bremin & Co AB
  6.                                            Box 22072
  7.                                            S-104 22 Stockholm
  8.                                            SWEDEN
  9.  
  10. Telefax:                                   +46-8-7325706
  11.  
  12. Complete this form, print it out, *SIGN* it, and send it to us.
  13. ---------------------------------------------------------------------
  14.  
  15. Card issued by:     [ ] VISA     [ ] MasterCard     [ ] EUROCARD
  16.  
  17. Additional options for Swedish residents only:      [ ] BankKort
  18.      [ ] Kopkort    [ ] Rikskort [ ] Sparbankskort  [ ] Nordbankskort
  19.   (svara med kryss: ska belastas [ ] bankkonto, eller [ ] kortkredit)
  20.  
  21.                     
  22.  
  23. Card number   ____________________________ Expiration date __________
  24.  
  25.  
  26.  
  27. Order total   SEK _______________ Date of order _____________________
  28.  
  29.  
  30.  
  31.  
  32. Signature     _______________________________________________________
  33.  
  34.  
  35.  
  36. Name          _______________________________________________________
  37.  
  38.  
  39.  
  40. Company       _______________________________________________________
  41.  
  42.  
  43.  
  44. Address       _______________________________________________________
  45.  
  46.  
  47.  
  48.               _______________________________________________________
  49.  
  50.  
  51.  
  52. Country       _______________________________________________________
  53.  
  54.  
  55.  
  56. Phone (day)   _________________________ (data) ______________________
  57.  
  58.  
  59. Birthdate (personnummer for Swedish residents): _____________________
  60.  
  61. ---------------------------------------------------------------------
  62.  
  63.  
  64. Bremin & Co AB                       Order Form 901105 (credit cards)
  65. ---------------------------------------------------------------------
  66.  
  67. Qty     Specification                Unit cost              Total
  68.  
  69.  
  70.  
  71. ____    FrontDoor 2.00           SEK ___________     SEK ___________
  72.                                  (see price list)
  73.  
  74.  
  75. ____    TosScan 1.00             SEK ___________     SEK ___________
  76.                                  (see price list)
  77.  
  78.  
  79.    1    Shipping and Handling    foreign: SEK 100    SEK ___________
  80.                                  domestic: SEK 60
  81.  
  82.  
  83. ____    Express delivery (*)                         SEK ___________
  84.                                                     -----------------
  85.  
  86.  
  87.         Subtotal                                     SEK ___________
  88.  
  89.  
  90.  
  91.         Swedish residents, add 25% MOMS              SEK ___________
  92.                                                     -----------------
  93.  
  94.  
  95.         Total                                        SEK ___________
  96.  
  97. ---------------------------------------------------------------------
  98.                                              Mark one!
  99.  
  100. Diskette type:                               [ ] 5.25"      [ ] 3.5"
  101.  
  102.                                               
  103. For TosScan, specify message base format:    [ ] QBBS/RA    [ ] MSG 
  104.  
  105.  
  106.  
  107. Network address: (zone:net/node, if affiliated) _____________________
  108.  
  109. ---------------------------------------------------------------------
  110.  
  111. Site licensing available. Please allow 2 - 4 weeks for delivery.
  112.  
  113. (*) Express delivery subject to availability, please call us and ask
  114. for a confirmation first! Actual rate depends on destination and will
  115. be declared in the confirmation.
  116.  
  117. All prices subject to change without prior notice; make sure to use
  118. the most recent order form. (Update) file request FDORDER from 
  119. 2:201/310@fidonet or 27:1346/100@signet if unsure of validity!
  120.