*** NASSI USAGE KEY ORDER FORM (ZAM) ***





+----------------------------------------+
|                                        |             Fax: +49 2461 61 8600
|                                        | 
|                                        |
|  Forschungszentrum Juelich GmbH        |
|  Finanzabteilung/Finanzbuchhaltung     |
|  D-52428 Juelich                       |
|  Germany                               |
|                                        |
|                                        |
+----------------------------------------+

Nassi licenses ordered:  ___  Total amount: EUR/$ ______  (Euro 30 or $30 per copy)

Platforms:  _________________

Method of payment:

  [ ] Invoice, I need an invoice before I can send payment.

  [ ] I pay by bank tranfer. 
      Recipient:              Forschungszentrum Juelich GmbH
      Bank:                   Sparkasse Dueren
      Bank code number:       395 501 10
      Account:                40030
      S.W.I.F.T.-address:     SDUEDE33
      Keyword (important!):   NASSI / SFM 027470

  [ ] I enclose a Check.
      Recipient:         Forschungszentrum Juelich GmbH
                         Finanzabteilung/Finanzbuchhaltung
                         D-52428 Juelich
                         Germany
 
  [ ] I enclose cash.
      Recipient:         Forschungszentrum Juelich GmbH
                         Finanzabteilung/Finanzbuchhaltung
                         D-52428 Juelich
                         Germany


My key should be sent to (please type or print clearly):

E-mail address (important!):   _________________________

Name:                    _______________________________

Organization :           _______________________________

                         _______________________________

Complete street address: _______________________________

                         _______________________________

                         _______________________________

Country:                 _______________________________


I accept the attached license agreement.

Date: ________                           Signature: __________________