Please print out the following Order Form, and fax or mail it to:

element 5 AG / ShareIt!
Vogelsanger Strasse 78

50823 Koeln
Germany

********
Please be sure to leave one full line between the Street
Address and the city and postal (zip) code.
********

Phone:  +49-221-2407279 
Fax:    +49-221-2407278
E-Mail: register@shareit.com

US customers may also order by calling 1-800-903-4152 (orders only
please!). US check and cash orders can be sent to our US office at

ShareIt! Inc.
PO Box 844
Greensburg, PA 15601-0844
USA

Tel. 724-850-8186
Fax. 724-850-8187

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Order Form for PsQRFilters Component
(tick or "*" in appropriate box)

Program No.: [ ] 136468 - PsQRFilters Site License (with source)        - US$ 149.95
             [ ] 136469 - PsQRFilters Single Developer (with source)    - US$  49.95
             [ ] 136470 - PsQRFilters Single Developer (without source) - US$  29.95

                 
Last name: ___________________________________

First name: ____________________________________

Company: ____________________________________

Street and #: ______________________________________

City, State, postal code: ________________________________

Country: _______________________________________

Phone: _____________________________________

Fax: ________________________________________

E-Mail: ______________________________________



How would you like to pay (tick or "*" in appropriate box):

credit card - wire transfer - EuroCheque - cash
    [ ]            [ ]           [ ]       [ ]


Credit card information (if applicable)

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

Card holder: ________________________________

Card No.: ___________________________________

Date of Expiration : ___________________________________



Date / Signature ___________________________


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