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  1.                       Order Form for agSI Version 1.2.2
  2.                     ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
  3.  
  4.      (please fill in / check:)
  5.                                              prices each    prices total
  6.  
  7.      ___ x Licence for agSI                $ 23 / DM 30,- * ->  __ _____
  8.            (you will recieve a registration code)               ^ currency
  9.  
  10.      ___ x 3 1/2" Disk with latest version  $ 4 / DM  5,- * ->  __ _____
  11.            default English; [ ] also German, [ ] only German
  12.            [ ] I want 5 1/4 " disk(s)
  13.            outside Europe additionally   1x $ 6 / DM  8,-   ->  __ _____
  14.  
  15.      * For discounts on quantity orders, see README or online help!
  16.  
  17.      Payment/Shipping:
  18.      ( )  C.O.D. (only inside Germany!)            DM  5,-  ->  __ _____
  19.      ( )  pre-paid (cash / cheque)                   --             --
  20.      ( )  Credit card    [ ] Visa     [ ] Diners Club               --
  21.                 [ ] Euro-/MasterCard  [ ] American Express
  22.            (charged in DM at current exchange rate)
  23.  
  24.           Card no.: ______________________ Expiration: __________
  25.           Name & address of card owner (if different from below):
  26.  
  27.           _______________________________________________________
  28.  
  29.           _______________________________________________________
  30.                                                              =============
  31.  
  32.      Total:  ------------------------------------------------>  __ _____
  33.  
  34.      [ ]  Inform me about "major" upgrades [ ] via e-mail [ ] via letter
  35.  
  36.      I got agSI from... __________________________________________________
  37.  
  38.      Comments: ___________________________________________________________
  39.  
  40.               ____________________________________________________________
  41.  
  42.      Name:    ____________________________________________________________
  43.  
  44.      Company: ____________________________________________________________
  45.  
  46.      Address: ____________________________________________________________
  47.  
  48.               ____________________________________________________________
  49.  
  50.               ____________________________________________________________
  51.  
  52.      E-Mail:  ____________________________________________________________
  53.      (accessible from the Internet)
  54.  
  55.  
  56.      Date: __________________   Signature: _______________________________
  57.  
  58.      Mail to:  Andreas Groegel           or (C.O.D./credit card) via
  59.                Hesserweg 3               e-mail (Internet) to:
  60.                D-70374 Stuttgart           ag@studbox.uni-stuttgart.de
  61.                Germany
  62.