PED 6 Order Form (August 2009)
NO HANDWRITING , PLEASE
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Please e-mail to: 	plendl@medgen.de
or fax to:		+49-(0)4323-96501

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Please enter your name and complete address:
Name:
Department:

Address:

City:
ZIP:
Country:
fax:   
e-mail: 
(The e-mail address where the registration key will be sent to!)
After registration, your department's name and location will appear in PED's status bar. 

>> Please tell me how this should look like (e.g., Institute of Human Genetics, Kiel):
>>
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LICENSE ORDER:
Department License				
For 1 to 10 users in a SINGLE department:
[    ]	PED 6 Standard
[    ]	PED 6 Linkage
[    ] 	Update PED 5 Linkage to PED 6 Linkage
Other licenses: please ask.

[    ] Payment in EUR:
license fee:	_______	EUR
handling	0.00  EUR
Total		_______ EUR

[    ] Payment in USD:
license fee:	_______	USD
handling	20.00	USD
Total		_______	USD

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METHOD OF PAYMENT (Check one):
 (Checks ONLY FROM COUNTRIES FROM THE EUROZONE. No credit cards)
 [    ] 	I enclose a check for the amount due, payable to 
   			Dr. H. Plendl, in EUR drawn on a German bank
 [    ] 	Please invoice my organization 		EUR / USD 	__	 
   	Purchase order No: 				__
 [    ] 	Please send me a proforma invoice 	EUR / USD 	__	
   	Purchase order No: 				__

Date:	_____________________

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All licenses are prepaid only. All orders outside of Germany must be prepaid.