Registration Form for ECMenu 3.10

Current price for 1 copy of ECMenu: US$ 20 (twenty US dollars)
(Ask for quantity discounts)

Name: ___________________________________________________

Address: ________________________________________________
         ________________________________________________
         ________________________________________________
         ________________________________________________

Country: ________________________________________________

Phone:   ___________________

FAX:     ___________________

E-mail:  ___________________

Where did you obtain this version of ECMenu?
____________________________________________

I would like to receive my registered copy of ECMenu

[ ] by mail at the above mentioned address.

[ ] by Internet electronic mail at the following address:
    ___________________________


Payment:

Amount to be paid:
ECMENU, delivered through Internet        US$ 20
+ US$ 5 for mail delivery                 ______
+ US$ 5 for cheque payment                ______
TOTAL                                     US$
                                          ======

I would like to pay:

[ ] by VISA credit card,
    Card Number: ____-____-____-____
    Expiration Date (month/year): __/__

[ ] by cheque

[ ] by money order to SWISS BANK CORPORATION, 6900 MASSAGNO, SWITZERLAND
    ACCOUNT NO. JC252.237 EUROCOM


      EuroCom
      P.O.Box 293
      CH-6900 Massagno
      (Switzerland)

      FAX:    +41 91 56 72 63
      E-mail: info@eclink.ch

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