An Orchid/Fuchsia cd and orchid-cd of orchids

ORCHID and FUCHSIA PRODUCTS MAIL/FAX ORDER FORM

CLICK HERE; PRINT THIS FORM AND FAX TO NUMBER: ++31 (313) 450 804
(where ++ denotes the international phone access code and 31 the country # of The Netherlands)

NAME AS ON CARD:.......................................................................................................

ADDRESS, STREET:........................................................................................................

CITY:...............................................................................................................................

STATE (+ ZIP):..................................................................................................................

COUNTRY:.......................................................................................................................

TELEPHONE NUMBER:.....++..............(....................)........................................................

FAX NUMBER:..................++..............(....................).........................................................

E-MAIL ADDRES:...............................................................................................................

CURRENT DATE (MONTH/DAY/YEAR).................................................................................

............ORCHID CD-ROM(S) English/Espaņol/Deutsch/Nederlands (PLEASE CIRCLE LANGUAGE) @ US$ 49.- (+US$ 5.50 S+H) EACH; TOTAL US$................................
(Free Orchid Databases CD ROM (English Langauage) is included)

............FUCHSIA CD-ROM(S) English/Nederlands (PLEASE CIRCLE LANGUAGE) @ US$ 34.- (+US$ 5.50 S+H) EACH; TOTAL US$................................

METHOD OF PAYMENT (PLEASE CIRCLE) :   VISA   /     MASTERCARD   /     AMEX   /     EUROCARD

CARD NUMBER:.................................................................................................................................

EXPIRATION DATE:............................................................................................................................

CVV2/CVC2 CODE:............................................... (The CVV2/CVC2 code is the three or four-digit security code that is printed on credit cards. The value appears in reverse italic at the top of the signature panel on the back of the credit card, or just above the end of the credit card number on the front of the card)

NAME AS PRESENT ON CARD:...............................................................................................................

SIGNATURE OF CARD HOLDER:.............................................................................................................

CLICK HERE; PRINT THIS FORM AND FAX TO NUMBER: ++31 (313) 450 804
(where ++ denotes the international phone access code and 31 the country # of The Netherlands)

OR MAIL TO: MöhltiMedia Publishing
ED.   V.   BEINUMLAAN   129
6952 CL   DIEREN
THE   NETHERLANDS

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