                   -----------------------------------------
                  | O R D E R - F O R M   M I C R O S C A N |
                   -----------------------------------------

Yes! I would like to order Microscan. Please send to me by airmail the latest 
and integral version of this program, including the printed manual, to: 

Name    :  ___________________________________________________________________

Address :  ___________________________________________________________________

           ___________________________________________________________________

           ___________________________________________________________________

Country :  ___________________________________________________________________

Callsign:  _ _ _ _ _ _
(please provide a personalized callsign if you want to use the transmit 
option, do not use general calls like 'mscan', 'sstv', 'color' etc.) 

Send me a.s.a.p. (tick your choice):

[ ]  Microscan 2.02 for fl. 95.- (US$ 60)

[ ]  Microscan 1.3 for fl. 50.- (US$ 30)

[ ]  Microscan RX interface for fl. 95.- (US$ 60)

I already have a registered version of Microscan and would like to: 

[ ]  upgrade from Microscan 2.01 to 2.02 for fl. 10.- (US$ 7)
     (or you can download this upgrade from our BBS at no cost)

[ ]  upgrade from an older version to Microscan 2.02 for fl. 50.- (US$ 30)

I will pay as follows:

[ ]  I have included cash (any currency will do)

[ ]  I have sent by separate mail a Post Office money order made out in Dutch 
     guilders 

[ ]  I have included a EUROcheque made out in Dutch guilders

[ ]  I will pay by [ ] Mastercard/Eurocard, [ ] VISA or [ ] JCB

     Card number            :  _ _ _ _  _ _ _ _  _ _ _ _  _ _ _ _

     Expiry date (good thru):  _ _  /  _ _

     Owner's name           :  _______________________________________________

     Owner's street address :  _______________________________________________

     Owner's postal/zip code:  _______________________________________________


     Owner's signature      :  _______________________________________________

[ ]  I have transferred the amount to [ ] Postbank Arnhem PSTBNL2A nr. 1747205 
     or [ ] Rabobank Rockanje nr. 35.57.02.606 for CombiTech in Rockanje and 
     will pay fl. 15.- (US$ 10) extra for the costs 

[ ]  I have included a cheque from my bank and will pay fl. 15.- (US$ 10) 
     extra for the costs 

(fl. is Dutch guilders)

Mail, fax or modem this form to:

CombiTech,
P.O. Box 507,
3235 ZG Rockanje,
The Netherlands.
Tel/Fax +31 181 40 4252
B.B.S.  +31 181 40 4513

                      ----------------------------------
                     | Thank you for your registration! |
                      ----------------------------------

