MEDIAMOND TMI - DELUXE SKI JUMP 3 ORDER FORM Name : _______________________________________________ Address: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ E-mail : _______________________________________________ I order the following items: Deluxe Ski Jump 3 [ ] Euro countries 10 EUR [ ] Czech Republic 250 CZK [ ] Poland 40 PLN [ ] Japan 1000 JPY [ ] Switzerland 13 CHF [ ] Norway 80 NOK [ ] USA 13 USD DSJ3 Online: 3-Month Subscription [ ] Euro countries 5 EUR [ ] Czech Republic 130 CZK [ ] Poland 20 PLN [ ] Japan 500 JPY [ ] Switzerland 7 CHF [ ] Norway 40 NOK [ ] USA 7 USD DSJ3 Online: 12-Month Subscription [ ] Euro countries 10 EUR [ ] Czech Republic 250 CZK [ ] Poland 40 PLN [ ] Japan 1000 JPY [ ] Switzerland 13 CHF [ ] Norway 80 NOK [ ] USA 13 USD I want to receive the registration key via: [ ] e-mail [ ] mail Type of Payment: [ ] I have enclosed the cash payment with my order. No cheques, please! [ ] I have transferred the payment to your bank account and enclose a copy of the bank receipt with my order. Pay To : Jussi Koskela Bank : Pohjola Bank Helsinki, Finland SWIFT (BIC) -code : OKOYFIHH IBAN : FI82 5132 0520 0464 34 Date and Signature: ____________________________________ ======================================================== Send orders and inquiries to us via mail or e-mail. Mediamond Tmi Nelikkotie 2 A 18 FI-02230 Espoo FINLAND E-mail: sales@mediamond.fi We usually ship within 24 hours.