  ORDER FORM - BKM2
 ================================================================
  Order for "Eric's Bookmark Integrator"


  Name:    ______________________________________________________

  Company: ______________________________________________________

  Address: ______________________________________________________

  State:   _______________________  Country: ____________________

  Phone:   _______________________      FAX: ____________________

  E-mail:  ______________________________________________________



  [ ] license(s), each      US$ 12.99  /  19.99 DEM (Deutsche Mark)
                                       /  German Currency when 
                                       /  paying with plastic
                                       /  or Eurocheck

  I will receive the registration key(s) by email.




  [ ] I will pay with my credit card:

      TOTAL in DEM (Deutsche Mark): __________

      ( ) Mastercard            ( ) Eurocard             ( ) VISA

      Card #_________________________________ Exp. Date:_________
 
      The name as it appears on the card: _______________________

      The signature of its owner authorizing us
      to debit it for the amount indicated above: 


      ________    ________________________________
      Date        Signature of Cardholder





  [ ] I will send Check by mail.

      Checks accepted:

      1. Checks drawn on an international bank having the
         address of a North American clearing office and a
         bank transit number printed on it. These Checks
         must be in US dollars - no other currency can be
         accepted.

      2. Eurochecks.
         These Checks must be in DEM (Deutsche Mark).
         The Check's card number must be on its back.
         Otherwise these Checks can not be accepted.


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 Send this form to:       Friedrich Datentechnik GmbH
                          An den Dreissigruten 51
                          D 64572 Buettelborn, Germany
 
                          FAX:    +49-6152-2255
                          email:  friedv@aol.com
