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  9.                                      ***MODULO DI RICHIESTA EVOCATION***
  10.    Si prega di compilare il modulo in ogni sua parte al fine di velocizzare al massimo
  11. la spedizione del gioco. Se possibile specificare comunque un  recapito fax, magari
  12. del vostro ufficio o di un  vostro amico.
  13.  
  14. Il sottoscritto  ____________________________  desidera ricevere la versione completa
  15. del videogioco ‚ÄúEvocation ‚Ä¢ La Sfida‚Äù al seguente indirizzo:
  16.  
  17.                      Nome e Cognome  ______________________________________
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  19.                                                                     Indirizzo  ______________________________________
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  21.                                                                                           _______   ________________________   ____
  22.                     
  23.                                                                 Paese  _______________________
  24.  
  25.                                                   Telefono  _______________________   Fax  _______________________
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  27. Pagher√≤ 25.000 lire comprensivi delle spese di spedizione, che verr√† effettuata nell'arco dei
  28. 5 giorni seguenti al ricevimento del presente coupon, tramite:
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  30.                                              [  ] Carta di Credito n¬∞    _  _  _  _  -  _  _  _  _  -  _  _  _  _
  31.                                                                         (la carta di credito deve appartenere al circuito VISA/MASTERCARD/EUROCARD)
  32.                     
  33.                                                                                        Scadenza     ____/____
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  35.                                                                   Intestata a   ________________________________
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  37.                                                          Nato il        ____ /____/________ 
  38.                                                                                                                                                     
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  40.                                                 [  ] Pagamento in Conto Corrente Postale.
  41.                                                                         Allego alla presente la copia della ricevuta del versamento sul C/C Postale n¬∞ 15518350
  42.                                                                         intestato a DedaloMedia - via don Giuseppe Lago, 52 - 35013 Cittadella (PD)
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  45.                                                 [  ]  L'invio dell'importo di 25.000 lire (contanti o assegno) che allego al presente coupon.
  46.                                                                             (l'assegno deve essere intestato a DedaloMedia)
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  49. Data _____________________                                                                                                                                                                            Firma _____________________
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  52.                                                   DEDALOMEDIA SOFTWARE ENGINEERING
  53.      VIA DON GIUSEPPE LAGO, 52 ‚Ä¢ 35013 CITTADELLA LOC. LAGHI (PD) ‚Ä¢ ITALY
  54.                                                   TELEFONO +39.49.9422115 ‚Ä¢ FAX +39.49.9422099
  55.                             APPLELINK ITA0749‚Ä¢INTERNET ITA0784@APPLELINK.APPLE.COM