TextPad Order Form (world-wide)/TextPad注文書

Payment may be made with a check, or various credit cards, in US dollars. However, please note that credit cards are charged in UK pounds, at the current exchange rate. See the Price List for dollar prices, and return the completed Order Form below.
支払いは、小切手、クレジットカードにてUSドルにて可能です。 しかしながら、クレジットカードはUKポンドの相場の為替にて請求されます。 ドルでの 値段表をご覧の上下記のフォームを記入ください。

Licenses required/ライセンス必要数:
    [  ] 1, [  ] 5, [  ] 10, [  ] 20, [  ] 50, [  ] Unlimited/無制限

Price:	__________
CD-ROM ($15.00):	__________
Total amount paid/合計金額:	__________

Method of Payment/支払方法:
    [  ]Check, [  ]MasterCard, [  ]VISA, [  ]AMEX,
    [  ]JCB, [  ]EuroCard, [  ]DELTA

Credit Card Number/クレジットカード番号:	_________________________
Expiry Date/有効期限:	____/_____
Name On Card/カード所有者の名前:	_________________________
Your Name 貴方のお名前(if different/もし異なる場合):	_________________________
Company/会社名:	_________________________
E-mail Address:	_________________________

Billing Address/請求書の送り先:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Country: ___________________

Please send this completed form with your check (if appropriate) to/このフォームをご記入の上、下記へお送りください:

Helios Software Solutions
PO Box 619
LONGRIDGE
PR3 2GW
England
FAX: +44 (0)1772 786375
E-Mail: sales@textpad.com

Thank you for your interest in this product.ありがとうございました