TSE WWW EDITION ORDER FORM (201009) Name: ______________________________________________________ [Company]: ______________________________________________________ Address: ______________________________________________________ City: ____________________________ Postal Code: ____________ Country: ____________________________ [State]: ________________ Phone: ________________________ Fax: ________________________ Email: ______________________________________________________ 24-month WWW edition at EUR 245 each ......................................___ x 245 ______ 12-month WWW edition at EUR 137 each ......................................___ x 137 ______ 12-month WWW edition 10 users pack at EUR 885 each ......................................___ x 885 ______ 3-month WWW edition at EUR 46 each ........................................___ x 46 ______ TOTAL EUR WITHOUT VAT.......................................... ______ If you are within EU and don't have a EU VAT number please add 19.6% VAT. If you have a EU number please state it: VAT ______ EU VAT number: ________________________________ TOTAL EUR WITH VAT (if applicable)............................. ______ PAYMENT ( ) Check (must be drawn on a French bank in EUR, payable to TBS) ( ) SWIFT (see details at https://www.TBS-internet.com/secure/rib.html ) ( ) Credit card (Visa/MasterCard/Amex): Number: ________________________________ Expiration: __________ Verification code: ________ Signature: __________________________________________________ Date: ________________________________ SEND TO: TBS internet 22 rue de Bretagne, 14000 CAEN, France Fax: +1-760-284-6216 or +33-2-3178-3187 (write in ALL CAPS) email: orders@TBS-satellite.com