44508A5A
Contact Bugfix by phone 0800-328-4157 or WEB SITE http://www.bugfix.co.uk 
Email: sales@bugfix.co.uk or press F3 to print a FAX order form.
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                      2000 Check FAX ORDER APPLICATION.
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Please complete the following in full and Fax to: 01722-322-198

Please supply a key code for the following Computer ID Number and deliver
that code by (delete as apropriate) Fax/Post/E-Mail
Post To: Bugfix,P.O. Box 1725, Salisbury, SP1 2UL 
Computer ID Number = 0003 

                              DELIVERY DETAILS:
                              ****************

Mr/Mrs/Ms:   First Name:................... Last Name:....................

Address 1:............................................

Address 2:............................................

City:.................................................

State/Province:....................   Zip/Postal Code:....................

Country:....................

Telehone:...............    Fax:...............    E-Mail:...............


                 CARDHOLDER ADDRESS IF DIFFERENT FROM ABOVE:
                 *******************************************

Mr/Mrs/Ms:   First Name:................... Last Name:....................

Address 1:............................................

Address 2:............................................

City:.................................................

State/Province:.....................  Zip/Postal Code:....................

Country:....................


                              PAYMENT DETAILS:
                              ****************

Credit card type:...................... Credit Card Number:...............

Name on Card:.......................... Expiry Date (mm/yy):..............


I authorise you to debit 19.99 from the above credit card.

Signature:.............................

