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  1.  ------------------------------------------------------------------------------------
  2.                       Payment by credit card for shareware
  3.                                 "EpsonShare"
  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.   
  15.  The server price varies by the number of clients you want to serve.
  16.  
  17.                         Number      French 
  18.                       of Clients    Francs       Euros     $USD
  19.                                                    
  20.                            1         160          25       24
  21.                            3         265          41       39
  22.                            5         380          58       56
  23.                           10         600          92       89
  24.                           20         809         123      119
  25.                           50         990         159      153
  26.                 
  27.  ------------------------------------------------------------------------------------
  28.  Your order
  29.        
  30.  Currency
  31.    If you reside in France, thank you to pay in French Francs. Euros only for
  32.    countries of the European community. Dollars US for all other countries.
  33.         
  34.  
  35.         Clients           Product            Price and Currency  
  36.  
  37.           ...           EpsonShare           ..................
  38.  
  39.                            Total             ..................
  40.  
  41.  ------------------------------------------------------------------------------------
  42.  
  43.             Your name: ...............................................
  44.   
  45.   Your e-mail address: ...............................................
  46.  
  47.          Your country: ...............................................
  48.  
  49.       Your fax number: ...............................................
  50.  
  51.    Your printer model: ...............................................          
  52.  
  53.     Credit card type  (Visa,American Express or Eurocard/Mastercard):
  54.               
  55.               ...............................................
  56.               
  57.                       
  58.     Your credit card number: ...................................
  59.                 
  60.                 Expiry date: ...................................
  61.               
  62.  ------------------------------------------------------------------------------------
  63.  Authorization
  64.     
  65.              I authorize S.E.S to charge my credit card for
  66.                        (Amount and Currency)
  67.                         
  68.                  ......................................
  69.                         
  70.                         
  71.                              signature:
  72.                         
  73.  
  74.  
  75.  
  76.  ------------------------------------------------------------------------------------
  77.