NetSoft Computer Networks
Last Updated
March 10th
1997

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http://www.netsoft.ie/

Order by FAX


When Ordering by FAX: Please send a FAX to NetSoft (Ireland) +(353) 91-529607 and include the following details:
  • If you have an email address we'll send your access codes to that email address as well as your mailing address.
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----- User information - (Required) --------------
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         First Name: _____________________________

          Lasr Name: _____________________________

    Internet E-mail: _____________________________
   (if you have one) e.g. username@yourhost.com

--------------------------------------------------
----- User Address - (Required) ------------------
--------------------------------------------------

       Company Name: _____________________________

     Street Address: _____________________________

               City: _____________________________

     State/Province: _____________________________

      Zip/Post Code: _____________________________

            Country: _____________________________

              Phone: _____________________________

                Fax: _____________________________

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Please tick were appropriate.

Payment/Cash/Cheque enclosed [ ] (tick 1 only)
Charge my card               [ ]

            Visa [ ]
      MasterCard [ ]
        EuroCard [ ]
       Discover  [ ]

Network License Fee $199.00 U.S.D

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----- Credit Card Information - (Required) -------
--------------------------------------------------

 Card Holder's Name: _____________________________

        Card Number: _____________________________

          Card Type: _____________________________

    Expiration Date: _____________________________

             Signed: _____________________________

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Copyright © 1997 NetSoft Computer Networks. All Rights Reserved.
20 Sea Road, Galway, Ireland.
Tel (353)+91-529607.