M-Base Engineering + Software GmbH Dennewartstr. 27 • 52068 Aachen • Germany Fax: +49-241-963-1469 • E-mail: [email protected] Order/Bestellung Material Data Center Number/ Product/Produkt Anzahl Price/ Preis Addition/ Summe € 350,- € VAT/ 19% MwSt. € Total/ Endsumme € Access to Material Data Center (12 months) Zugang zu Material Data Center (12 Monate) o Please extend automatically after one year for another 12 months/ Bitte um automatische Verlängerung um jeweils ein Jahr nach Ablauf o We want to pay via invoice/ Wir möchten per Rechnung zahlen o We want to pay with Credit Card/ Wir möchten mit Kreditkarte zahlen o VISA Card* o Master Card* Name: ............................................................................................. Company/Firma: ............................................................................................. Address/Adresse: ............................................................................................. ............................................................................................. Phone/Telefon: ............................................................................................. Telefax: ............................................................................................. E-mail: ............................................................................................. for EU customers VAT number:/ für EU Kunden UST.-IdNr.: ............................................................................................. Date/Datum: Signature/Unterschrift: ............................................................................................. ------------------------------------------------------------------------------------------------------------------------------ *Credit Card/Kreditkarte Credit card holder/Kreditkarteninhaber: ...................................................................... Credit card number/Kreditkartennummer: ...................................................................... Valid thru/Gültig bis: ...................................................................... CVC Card Validation Code/3-stellige KPN: ...................................................................... Date/Datum: Signature/Unterschrift: ......................................................................