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Text File  |  1997-01-02  |  1.6 KB  |  49 lines
  1.     Lastname, Name  : __________________________________________________
  2.  
  3.     Company ____________________________________________________________
  4.  
  5.     Address ____________________________________________________________
  6.             ____________________________________________________________
  7.     Phone   _________________________  Fax._____________________________
  8.  
  9.  
  10.     JDS - Software Vertrieb
  11.     Jens Driese                                   Fax.: +49-4451-959196
  12.     P.O. BOX 1269                                 CIS:  100273,2252
  13.                                                   BBS:  +49-4451-959193
  14.     D-26302 Varel                                 CIS:  GO JDSONLINE
  15.  
  16.  
  17.  
  18.  
  19.     Order:
  20.     --------------------------------------------------------------------
  21.     Qty
  22.  
  23.     ____   Atlantis V2.60 for Windows  ($30)  DM 45,00  =    _____ DM
  24.  
  25.      1     Shipping/handling overseas  ($10)  DM 15,00  =     15,- DM                      
  26.  
  27.                                                      Total   _____ DM
  28.  
  29.  
  30.     Billing method
  31.  
  32.     ( ) Cash
  33.     ( ) Creditcard (VISA/DINERS/EURO/MASTER-CARD)
  34.  
  35.     Number:_______________________ Exp.-Date:___________
  36.     Owner :_____________________________________________
  37.     Card  :( ) VISA   ( ) DINERS  ( ) EURO/MASTER
  38.  
  39.  
  40.     Comments____________________________________________________________
  41.  
  42.             ____________________________________________________________
  43.  
  44.             ____________________________________________________________
  45.     
  46.  
  47.                                                   ______________________
  48.                                                          Signature
  49.