PhotoRescue Order Form : to be faxed to +32-4-3446514

Shipping address ( PhotoRescue may be downloaded, shipped or e-mailed )
Name		
Company		
Address		
Address		
City		Country		
Phone		Fax		
E-mail						
VAT*		*EEC corporations only	

Billing Address
Name		
Company		
Address		
Address		
City		Country		
Phone		Fax		

Credit Card Information						Signature
Credit Card Type	          Visa J          MasterCard J	
Credit Card Number		
Expiration Date		
Signature		

Product	Type	Quantity	Price		
PhotoRescue	Standard Edition		29 USD		
	License for one private user, includes individual support.				
					
PhotoRescue	Photography Store Edition		99 USD		
	License for photography store offering occasional datarecovery services. Includes extended support.				
					
PhotoRescue	Data Recovery Service Edition		495 USD		
	License for data recovery service providers. Includes extended support, updates, case by case analysis and upgrades.				
					
PhotoRescue	Site Licenses 		Contact us		
					
		Subtotal
VAT 21%*
Total		

DataRescue sa/nv				        	--- Banking Information ---
40 Blvd Piercot						Fortis Bank    
4000 Liège, Belgium					rue Montagne du Parc 3
VAT: BE-448270553 					1000 Brussels, Belgium
Tel : +32-3446510					SWIFT GEBA-BEBB
Fax: +32-3446514					account : BE13 0012 7102 4039 (EUR) 
e-mail : sales@datarescue.com				account : BE12 0054 3431 7892 (USD)

I am paying by advance bank transfer, please register my order and wait for payment                    J	
I want to send a purchase order (governments, fortune 1000 and existing customer only)                J	

(*) VAT applies only in European Economic Community.  EEC Companies should either provide their VAT number or add the Belgian VAT. Private Users should add the Belgian VAT