Order Form for SPLOT - The Plotter Simulator (V7.x)

                  Select "File-Print Topic" from the menu bar to print this form.

This form is for postal or fax orders. On-line form is avaialble at http://www.swplot.com/order.htm.

Your Name:__________________________________________________________

Company: ___________________________________________________________

Address: ____________________________________________________________

      City: _____________________________  Prov/State:______________________

Country: _____________________________  ZIP/Postal:______________________

E-mail: ______________________________  Tel./Fax:_________________________

Indicate whether or not are you or your company registered VAT payer:

[   ] No

[   ] Yes and the VAT number is: ___________________________

If you are registered user already, your serial number: ________________

Licence:  [   ]  single user     [   ]  multi user               [   ]  LITE version

Number of users : ________

Payment:        [   ]  PayPal (you will receive instructions via e-mail)

                       [   ]  Cash (money enclosed)

                       [   ]  Credit card (fill out credit card information below)

                       [   ]  Bank or travelers cheque or International Money Order

                       [   ]  Send me a proforma-invoice first

License price ........................................................................... ____________ EUR

(Please use the registration fee dialog to calculate the correct price)

VAT (see below notice) .......................................................... ____________ EUR

TOTAL AMOUNT ...................................................................... ____________ EUR

VAT notice: EU residents without VAT number or Czech residents must pay

also   Czech VAT (see http://www.swplot.com/czvat.htm). Customers with

VAT number outside Czech Republic owe VAT in their country.

I hereby authorize the above amount to be charged to my

    [   ] MasterCard          [   ] VISA

Name as it appears on card:____________________________________________

Card number:________________________________ Expiration date:___________

Signature:___________________________________

For MC or VISA card CVC/CVV code (last three digits of number

contained in the signature strip on reverse side of your card): _____________

Your comments: ________________________________________________________

______________________________________________________________________

______________________________________________________________________

                            (add any additional comments you wish separately)

Mail this form to:            Alexandr Novy

                                    Chynovska 487

                                    391 56 Tabor

                                    Czech Republic

or fax it to: +420-381-254870

or e-mail it to anovy@swplot.com (but do not e-mail card orders).