TO:  REFCO (SCOTLAND)
     BOX 14461
     GLENROTHES,FIFE
     SCOTLAND, UK                         E-MAIL: 101473,500@compuserve.com
============================================================================
                  ORDER FORM for LWHIZ V1.21 Source Code Package
============================================================================
 I/We wish to order the FULL source code package for LWHIZ. I enclose FULL 
 payment for the equivalent of 45 Pounds Sterling. UK ONLY- Please ADD VAT

 I/We have read and I/We agree to acceptance of the conditions stipulated 
 within Note 19 of the LWHIZ V1.21 README.TXT document.

    FROM:                          TODAYS DATE: ________________  

    NAME:_______________________________________________________

    COMPANY:____________________________________________________

    ADDRESS: ___________________________________________________
         
             ___________________________________________________

             ___________________________________________________

    POST/ZIP CODE: ________________  COUNTRY: ___________________ 

    E-MAIL: _______________________  FAX: _______________________  

    PHONE (DAY): __________________  PHONE (EVENING): __________________

 METHOD OF PAYMENT (To Be Enclosed): _____________________________________
 ( UK customers ONLY - Please Add VAT )
=============================================================================
******* PAYMENT NOTES

 UK Customers use Cheque, PO or Bankers Draft

 NON-UK Customers can use one of the following schemes:

 A BANKERS DRAFT drawn on a UK bank (apply to your own bank for this)
                                OR
                            EUROCHEQUE
                                OR
                           EURO TRANSFER

 All Amounts should be for the Sterling Equivalent of 45 Pounds (excl. VAT) 

 Money transfers etc to OUR BANK at:  THE BANK OF SCOTLAND
                                      9 FALKLAND GATE
                                      GLENROTHES
                                      FIFE  KY7 5LW                           
                                      SCOTLAND, UK

   BANK SORT CODE: 80-08-09       OUR ACCOUNT NUMBER: 00342209 
                                  OUR ACCOUNT NAME:   REFCO (SCOTLAND)
=============================================================================
 We can process your order most efficiently, if you e-mail us first 
=============================================================================
