Alberto Rodrguez Aragons. The Quimeras Company             Contribution Form
Francisco Pizarro,3-2B                                     Fax - 34-959-011502
21003 Huelva, SPAIN                                           ntsu@teleline.es
http://teleline.terra.es/personal/quimeras/ntsu

Please complete the information below and mail or fax with payment. 

==============================================================================

Contact Name:     ____________________________ Company: ______________________

Shipping Address: ____________________________________________________________

(No PO Boxes)     ____________________________________________________________

Email Address:    ____________________________________________________________

Phone Number:     ____________________________ Fax Number: ___________________

==============================================================================

Product:                                               Users      Contribution
                                                                    
NTsu 2.0 Single User (Intel)                           (   )            10.00

NTsu 2.0 Company License (Intel)                       (   )       x     5.00



Total Enclosed:                                                    __________

                                               Other Currency (   ) __________

==============================================================================

Payment Method: ( ) Visa ( ) Mastercard

Credit Card Number: ________________________________ Exp: ____________________

Name On Card (EXACTLY): ____________________________ PO Number: ______________

Signature: _________________________________________ Date: ___________________

=================================================================(01/09/99)====

Notes: You can substitute Euros() for US$
