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  1.  ------------------------------------------------------------------------------------
  2.                       Payment by credit card for shareware
  3.                                  "TrashCleaner 2"
  4.  ------------------------------------------------------------------------------------
  5.             Postal courier                 |              Fax
  6.                                            |
  7.           Send this form to:               |         Send this form to:
  8.                S.E.S                       |
  9.          1, rue de stockholm               |     From France: 02 31 14 90 18
  10.             75008. Paris                   |    From Foreign: +33 2 3114 9018 
  11.                FRANCE                      |
  12.  ------------------------------------------------------------------------------------
  13.  Pricing  
  14.                                    French 
  15.                        Copies      Francs      Euros     $USD
  16.                                                    
  17.                            1        100          15       16
  18.                            5        350          53       58
  19.                           10        500          76       83
  20.                           20        600          91      100
  21.                           50       1000         150      160
  22.                 
  23.  ------------------------------------------------------------------------------------
  24.  Your order
  25.        
  26.  Copies
  27.    For private individual, only one copy is necessary for all computers used in the
  28.    family framework.
  29.    For companies, one copy by computer is necessary, see above quantitative discounts.
  30.                 
  31.  Currency
  32.    If you reside in France, thank you to pay in French Francs. Euros only for
  33.    countries of the European community. Dollars US for all other countries.
  34.    
  35.  
  36.    Do you want to receive your serial number
  37.         ... By e-mail (free)
  38.         ... By fax (extra charge 1.5 Euros or $USD 2.00)
  39.         ... By postal courier (extra charge 1.5 Euros or $USD 2.00)
  40.  
  41.     Do you want an invoice ?
  42.         ... No
  43.         ... By e-mail (free)
  44.         ... By fax (extra charge 1.5 Euros or $USD 2.00)
  45.         ... By postal courier (extra charge 1.5 Euros or $USD 2.00)
  46.         
  47.     If you desire to receive your serial number AND an invoice by fax or by postal
  48.     courier, count the extra charge only ONCE
  49.         
  50.  
  51.         Copies            Product            Price and Currency  
  52.  
  53.           ...           TrashCleaner 2       ..................
  54.           ...           extra charge         .................. 
  55.  
  56.                              Total           ..................
  57.  
  58.  ------------------------------------------------------------------------------------
  59.  
  60.             Your name: ...............................................
  61.           Your e-mail: ...............................................
  62.               Address: ...............................................
  63.                        ...............................................
  64.             City/Etat: ...............................................
  65.       Postal Code/Zip: ..................../..........................
  66.               Country: ...............................................
  67.            Fax number: ...............................................
  68.         
  69.     Credit card type  (Visa,American Express ou Eurocard/Mastercard):
  70.               
  71.               ...............................................
  72.     
  73.     Your first name and name, as they are registered on your credit card: 
  74.               
  75.               ...............................................
  76.                       
  77.     Your credit card number: ...................................
  78.                 Expiry date: ...................................
  79.               
  80.  ------------------------------------------------------------------------------------
  81.  Authorization
  82.     
  83.              I authorize S.E.S to charge my credit card for
  84.                        (Amount and Currency)
  85.                         
  86.                  ......................................
  87.                         
  88.                         
  89.                              signature:
  90.                         
  91.  
  92.  
  93.  
  94.  ------------------------------------------------------------------------------------
  95.