Please fill up this form completely and send it

by eMail to 
   orders@web-sms.net or

by sMail to
   GlaserSoft
   P.O. Box 419
   La Paz
   Bolivia


PURCHASE ORDER FORM

I want to order a license for WebSMS.


( ) Please send me my personal user key for
    the standard version of WebSMS for
    20,00 EUR.


( ) The total amount has been transfered to the
    Deutsche Bank 24 AG (Karlsruhe)
    Account number: 0100 792 00
    BLZ: 660 700 24
    SWIFT-Code: DEUTDESM 660


( ) The total amount is included as an international
    cheque with this order form.


 
USER INFORMATION

     Name: ___________________________
  Address: ___________________________
    City : ___________________________
ZIP-Code : ___________________________
  Country: ___________________________

   E-Mail: ___________________________
    Phone: ___________________________
      Fax: ___________________________



Date, Signature: _____________________


Where did you hear about WebSMS?

 ( ) Friends
 ( ) Colleagues
 ( ) CompuServe/AOL
 ( ) Internet:______________________
 ( ) Mailbox:_______________________
 ( ) Others:________________________


Problems/Suggestions/Remarks:

 ___________________________________
 ___________________________________
 ___________________________________
 ___________________________________
 ___________________________________