TO: REFCO (SCOTLAND) BOX 14461 GLENROTHES,FIFE SCOTLAND, UK E-MAIL: scorefco@aol.com ============================================================================ ORDER FORM for LWHIZ V1.32 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 V1.32 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 =============================================================================