This form is for mail based orders of Restorator, i.e. non
web-based orders.
Please print and fill out. See purchase.html for details.
Program No.: 103068
Number of copies to purchase:
___ Regular 60 Euro
___ Student 30 Euro
Last name: | ________________________________________________ |
First name: | ________________________________________________ |
Company: | ________________________________________________ |
Street and #: | ________________________________________________ |
City, State: | ________________________________________________ |
Postal code: | ________________________________________________ |
Country: | ________________________________________________ |
Phone: | ________________________________________________ |
Fax: | ________________________________________________ |
E-Mail: | ________________________________________________ |
How would you like to receive the license key and full version?
__ e-mail __ postal mail
How would you like to pay:
__ credit card __ wire transfer __ cash
Credit card information (if applicable)
Credit card: __ Visa __ Eurocard/Mastercard __ American Express __ Diners Club
Card holder: | ________________________________________________ |
Card No.: | ________________________________________________ |
Date of Expiration: | ________________________________________________ |
Date /Signature |
________________________________________________ |