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Text File  |  1999-11-27  |  1.8 KB  |  73 lines
  1. Order form for WAVmaker Standard
  2. ================================
  3.  
  4. Program number: 101981
  5.  
  6. Price: $49
  7.  
  8. Last name: __________________________________________________________
  9.  
  10. First name: _________________________________________________________
  11.  
  12. Company: ____________________________________________________________
  13.  
  14. Street and number: __________________________________________________
  15.  
  16. City: _______________________________________________________________
  17.  
  18. State: ______________________________________________________________
  19.  
  20. Postal code: ________________________________________________________
  21.  
  22. Country: ____________________________________________________________
  23.  
  24. Phone: ______________________________________________________________
  25.  
  26. Fax: ________________________________________________________________
  27.  
  28. E-Mail: _____________________________________________________________
  29.  
  30.  
  31. The GSound 44 CD-ROM will be sent to you by postal mail.
  32.  
  33. Payment method:
  34.  
  35. [ ] Credit card
  36. [ ] Bank wire
  37. [ ] EuroCheque (DM-denominated only - send to European address)
  38. [ ] US check (send to US address)
  39. [ ] Cash (US dollars)
  40.  
  41. ---
  42.  
  43. If you select "Bank wire", your order will be 
  44. processed when the payment is received at the 
  45. following account:
  46.  
  47. Account holder: element 5 AG
  48. Bank:           Postbank Koeln, Germany
  49. Bank number:    370 100 50
  50. Account number: 692 77-506
  51.  
  52. ---
  53.  
  54. Credit card information (if applicable)
  55.  
  56. Credit card: 
  57.  
  58. [ ] Visa
  59. [ ] Mastercard / Eurocard
  60. [ ] American Express
  61. [ ] Diners Club
  62.  
  63. Card holder: ________________________________________________________
  64.  
  65. Card number: ________________________________________________________
  66.  
  67. Date of Expiration : ________________________________________________
  68.  
  69. ---
  70.  
  71. Date / Signature ____________________________________________________
  72.  
  73.