Quimeras Software Company Registration Form Francisco Pizarro,3-2B Fax: +34 639 118657 21003 Huelva, SPAIN e-mail: quimeras@quimeras.com http://www.quimeras.com Please complete the information below and mail or fax. ============================================================================== Contact Name: ____________________________ Company: ______________________ Shipping Address: ____________________________________________________________ ____________________________________________________________ Email Address: ____________________________________________________________ Phone Number: ____________________________ Fax Number: ___________________ Comments: ____________________________________________________________ ____________________________________________________________ ============================================================================== Product: TqcRunas 2004.3 Edition Select Price ------------------------------------------------------------------------------ TqcRunas Company License for 10 users [ ] EUR 80 TqcRunas Company License for 25 users [ ] EUR 175 TqcRunas Company License for 50 users [ ] EUR 300 TqcRunas Company License for 100 users [ ] EUR 500 TqcRunas Company License for 250 users [ ] EUR 1000 TqcRunas Company License for 500 users [ ] EUR 1500 TqcRunas Company License for 1000 users [ ] EUR 2000 TqcRunas Company License for 1500 users [ ] EUR 2500 TqcRunas Company License for 2000 users [ ] EUR 3000 TqcRunas Company License for 3000 users [ ] EUR 4000 TqcRunas Company License for unlimited users [ ] EUR 5000 Total Enclosed: EUR __________ ============================================================================== Payment Method: ( ) Visa ( ) Mastercard Credit Card Number: ________________________________ Exp: ____________________ Name On Card (EXACTLY): ____________________________ PO Number: ______________ Signature: _________________________________________ Date: ___________________ ============================================================================== If your company needs a formal offer, please ask for it to: quimeras@quimeras.com PRIVACY ------- QUIMERAS SOFTWARE COMPANY firmly committed to protecting the privacy of its customers and those who sample our products. QUIMERAS SOFTWARE COMPANY does not share, sell, or otherwise distribute the financial or personal information of its customers or those who otherwise provide personal information to sample our products. All financial and personal information collected by QUIMERAS SOFTWARE COMPANY is held in the strictest confidentiality. Financial and personal information provided for orders is used to process payment and to send order information to our customers. More than anything, QUIMERAS SOFTWARE COMPANY tries to treat its customers as each one of us would like to be treated. We value our privacy and we value yours, too. It is our goal to make your experience with TQC a safe and positive experience. For more information on QUIMERAS SOFTWARE COMPANY privacy policy, please feel free to contact us at: quimeras@quimeras.com