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triadis engineering GmbH TrDBCtrls Order Form
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Attention
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               triadis engineering GmbH       Fax:   ++41(31)7681516
               Eichholzstrasse 7              eMail: sales@triadis.ch  
               CH-3254 Messen
               Switzerland

From
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   First Name: _______________________________________________________

    Last Name: _______________________________________________________

      Company: _______________________________________________________

 
      Address: _______________________________________________________

         City: _______________________________________________________

  Postal Code: _______________________________________________________

      Country: _______________________________________________________


      Phone #: _______________________________________________________

        Fax #: _______________________________________________________

       E-Mail: _________________________________________(PLEASE PRINT)


Order Details
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Delphi 2/3

 Qty                                                      $US      CHF

 [  ] TrDBCtrls (incl. source code).....................   40       60

 Software is shipped via the Internet, 
 at no additional cost.
 
                                                Total: $_____ CHF_____


Credit Card Details
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                Card Type: VISA ___ 	MasterCard ___

              Card Number: ___________________________________________
 
          Expiration Date: ___________________________________________

       Card Holder's Name: ___________________________________________

  Card Holder's Signature: ___________________________________________

			-->MasterCard is charged in CHF (Swissfrancs), 
			   rate of exchange by date of Order.


                 Comments: ___________________________________________

                           ___________________________________________

                           ___________________________________________

                           ___________________________________________
