Order Form for Software by Timo Esser

Please print this form and fax or send it to:

ShareIt! Inc. P.O. Box 844 Greensburg , PA 15601 ,  USA Phone: (724) 850 - 8186 Fax: (724) 850 - 8187

OR

ShareIt! element 5 AG Vogelsanger Str. 78 50823 Cologne Germany Fax: +49-221-31088-29

 

Please fill in the number of licenses required for the program(s) you would like to order:

Quantity	Program	Program ID#
	Test Tone Generator	300154061
	Rife Generator	300154105
	Multi Tone Generator	300154104
	Home Audiometer Hearing Test	300154102
	RPM Engine Tacho	300154109
	ABX Player	300154108
	Strobe Sync Pulse Generator	300154106

How would you like to receive the unlocking code (A sequence of numbers and letters)?
[  ] e-mail (recommended) - [  ] fax - [   ] postal mail

How would you like to pay?
[  ] Credit card - [  ] Wire transfer - [  ] Check - [  ] Cash

Credit Card Information (if applicable)

Credit Cards: [  ] Visa - [  ] Eurocard/Mastercard - [  ] American Express - [  ] Diners Club

Card Holder: ________________________________

Card No.: ___________________________________

Expiration Date: ________

Date / Signature: ___________________________