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Text File  |  1997-12-23  |  1KB  |  38 lines
  1.                                         =======   TACTICAL SOFT
  2.                                         SEND TO   MICROCOSME
  3.                                         =======   5, PLACE PASTEUR
  4.                                                   25000 BESANCON
  5.                                                   FRANCE
  6.  
  7.                                          ======
  8.                                          E-MAIL   info@tacticalsoft.com
  9.                                          ====== 
  10.  
  11. ====================
  12. YOUR DELIVERY ADRESS
  13. ====================
  14.  
  15.       Name: _________________________________
  16.  
  17.    Address: _________________________________
  18.  
  19.       City: _________________________________
  20.  
  21.   ZIP Code: _____________________________
  22.  
  23.    Country: _____________________________
  24.  
  25.  
  26. =======================================
  27. For a total amount of 150 French FRANCS
  28. =======================================
  29.  
  30.  Card Number _________________________________________________________
  31.  
  32.  
  33. Expiration Date ______________
  34.  
  35.  
  36.  
  37. Card Holder's Signature REQUIRED ____________________________________
  38.