Print this page, fill the fields and fax it to:

Media Connect
Gratzmüllerstr. 1
D-86150 Augsburg
Germany

Fax international: 0049 821 / 347 52 49, from Germany: 0821 / 347 52 49

Fax Order Form:

Company Name:

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Contact Person:

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Adress:

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for orders from the EEC:
European Sales Tax Number:

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Country:

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EMail adress:

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Payment via:

O MasterCard / EuroCard   O Visa   O American Express

Cardholders Name:

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Number of Credit Card:

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Valid thru:

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Product:

O "Attrib Xtra" (60 US$) O "HTML Xtra" (129 US$)
O "Border Xtra" (99 US$) O "Index Xtra & Toolkit" (399 US$)
(including the "HTML Xtra")
O "WinGroup Xtra" ( 99 US$ )
Customers from Germany please note, that we have to charge the sales taxes of currently 16%
Customers from the EEC, please attach your VAT Number, otherwise we have to charge 16% sales taxes.