PCB2htm Order Form
~~~~~~~~~~~~~~~~~~

We accept the following payment methods for PCB2HTM

* credit card; via fax, e-mail, or post
* International Money Order, payable in South African Rands; via post
* a cheque drawn from any bank in your country, in your country's currency
  for the equivalent price in $US; via post

          Our fax number is:   +27 11 886-4970
      Our e-mail address is:   sales@nez.com
Our WWW URL for PCB2htm is :   http://www.nez.com/pcb2htm.htm
      Our postal address is:   Connectica
                               PO Box 1004
                               Randburg
                               2125
                               Gauteng
                               South Africa

All payments should be made out to "Connectica". Please fill out this
form and send it to us via one of the above methods. Your full version
of PCB2HTM will be e-mailed to you in a few days.

The support contract entitles you to technical support by e-mail and free
upgrades to your version of PCB2HTM, for 12 months from the date of sale.
for further support you can use the PCB2HTM mailing list. See our web site
for further details.

Product                                     Price     Quantity  Total US$
=======                                     =====     ========  =========
PCB2HTM                                     US$30.00  ________  _________

Total Price (in US$)                    
                                                           ==============
How would you like to pay for PCB2HTM ? (check one)

Cheque (enclosed)                      (  )
International Money Order (enclosed)   (  )
Credit card:   VISA                    (  )
               Mastercard              (  )
               (we regret that we cannot accept any other credit cards)

  Name on card:________________________________________________________

  Card number: ________________________________________________________

  Expiry Date: _________________________


  Signature:   ________________________________________________________


Name for Registration:_________________________________________________

E-mail address:________________________________________________________

Thank you for purchasing PCB2HTM, we hope you enjoy using it.

Ian Gerada
ian@nez.com