Oliver Ebert
Software-Entwicklung
Postfach 100 501
D-78405 Konstanz
- Germany - 

Fax : +49 (7531) 1 71 22

E-Mail:oliver.ebert@t-online.de
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Name:
Company:
Street:
ZIP:
City:
Country:
Phone:
Fax:
E-Mail:

Yes, please send me the registered version of DIABASS® for 89 DM (German Marks). 

For shipping and handling, please add:

[ ] for shipping in Germany 	: 10 DM

[ ] other countries		: 20 DM	

[ ] via Air-Mail     additional	: 10 DM


Payment method:

[ ]	A EuroCheque (EC), drawn to the total amount of ____  DM  is enclosed.	


[ ] 	Please charge my VISA - Card with the total amount of ____ DM
	
 	Card No.: _ _ _ _  _ _ _ _  _ _ _ _  _ _ _ _	

	Exp. date:
		

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I agree, that

the program DIABASS® is being made available on an "as is" basis, 
and carries no warranties, expressed or implied.
The author shall in no way be held liable for any damages
resulting from the use of this program or the media on which it is distributed, 
including, without limitation, misrepresentation of data, loss of information, 
damage to equipment, or any other incidental or consequential damages.
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The software shall be stamped with the following name:

[_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _]


Date:

Signature: