          

Mail this form and a check/International postal money order to:

    MochaSoft
    Faksegade 13,1tv
    2100 Copenhagen East
    Denmark

Products:

Mocha W32 TN3270:
  __ single user Licenses of 25 USD each    = ______
  __ Unlimited Company licens of 250 USD    = ______

Danish Residents add 25% tax                + ______

Total:                                        ______



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 - For Checks less than 100 USD and if the Check is not drawn on a 
   Danish bank add 5.00 US for extra cost. 

 - Using Danish Checks,  1US = 6.00 dkr

 - You can pay with a check in any hard currency. Just use an exchange
   rate from a newspaper.


For EU (EEC) countries: Company VAT Number : ______________________

License name: ___________________________________ (will be displayed
                                                  in the help window)

Date:_______________

Company:___________________________________________________________

Contact Person: ___________________________________________________

Address:___________________________________________________________

City, State, Zip:__________________________________________________

Country:___________________________________________________________

E-Mail Address:____________________________________________________


If You want to speed up the order handling, send also this file via
email to frydendal@mochasoft.dk
