Full Name:
                 ---------------------------------
Contact person:
                 ---------------------------------
Street:
                 ---------------------------------
Zip, City:
                 ---------------------------------
Country:
                 ---------------------------------
E-Mail or Fax: 
                 ---------------------------------
 

    Ingenieurbuero Hoyer             +------------------------+
                                     ! Fax:   +49 40 52950607 !
    Hopfenweg 207                    +------------------------+

    D - 22851 Norderstedt
 
    Germany



O R D E R :

    Licence(s) Bootmanager BOOTSTAR each US$ 15.00  US$     .00
---  (Please fill in the number of systems)

( ) Registration Key, Invoice via E-Mail US$  0.00  US$     .00
( ) Registration Key, Invoice via Fax    US$  5.00  US$     .00
( ) Disk, Invoice via postal mail        US$ 10.00  US$     .00
                                                    -----------
      Total                                         US$     .00
                                                    ===========
Payment Options:

( ) Cash (only US$, not a draft)
                                   ----------------------------
( ) VISA                            Card owner

( ) Euro-/MasterCard
                                   ----------------------------
( ) American Express                Card number

( ) After receiving Invoice
    (only to companies,            ----------------------------
     min. of 5 licences,            Expire date
     shipping not via E-Mail)


                     ----------    ----------------------------
                      Date          Signature (Card owner)