Payment by credit card for shareware "EpsonShare" ------------------------------------------------------------------------------------ Postal courier | Fax | Send this form to: | Send this form to: S.E.S | 1, rue de stockholm | From France: 02 31 14 90 18 75008. Paris | From Foreign: +33 2 3114 9018 FRANCE | ------------------------------------------------------------------------------------ Pricing The server price varies by the number of clients you want to serve. Number French of Clients Francs Euros $USD 1 150 25 24 3 250 41 39 5 350 57 56 10 550 90 89 20 750 123 119 50 950 155 153 ------------------------------------------------------------------------------------ Your order Currency If you reside in France, thank you to pay in French Francs. Euros only for countries of the European community. Dollars US for all other countries. Clients Product Price and Currency ... EpsonShare .................. Total .................. ------------------------------------------------------------------------------------ Your name: ............................................... Your e-mail address: ............................................... Your country: ............................................... Your fax number: ............................................... Credit card type (Visa,American Express ou Eurocard/Mastercard): ............................................... Your credit card number: ................................... Expiry date: ................................... ------------------------------------------------------------------------------------ Authorization I authorize S.E.S to charge my credit card for (Amount and Currency) ...................................... signature: ------------------------------------------------------------------------------------