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 REGISTRATION                                                   Jean SUZINEAU
 jsDocumenteur 1.0                                              Route de Bridal
                                                                F-19130 OBJAT
                                                                FRANCE

LAST NAME/first name:___________________________________________________________

Company:________________________________________________________________________

Address:________________________________________________________________________

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Postal Code/Zip Code:___________________________________________________________

State/Province:_________________________________________________________________

Town:__________________________________________________________________________


Country:________________________________________________________________________


Telephone(optional):____________________________________________________________

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e-mail(optional):_______________________________________________________________


I order a licence of jsDocumenteur at the price of US$ 20.

I will receive a personalized copy of jsDocumenteur on a 3''1/2 floppy disk
Shipping and handling included.
Licence applies for the 3 variants of jsDocumenteur which will be on the disk:
 -"add-in" Expert variants for Borland Delphi 2(tm) and for Borland Delphi 3(tm)
 - standalone program variant
TOTAL : US $ 20
CREDIT CARD: Visa/Mastercard

CARD NUMBER__________________________________EXPIRATION DATE:_________

Signature:


               Jean SUZINEAU - Freelance worker in data-processing
               SIRET   n 412 851 628 00013 APE/NAF n 721Z
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