MEDIAMOND TMI - DELUXE SKI JUMP 4 ORDER FORM

Name   : _______________________________________________

Address: _______________________________________________
         _______________________________________________
         _______________________________________________
         _______________________________________________

E-mail : _______________________________________________


I order the following items:

Deluxe Ski Jump 4

 [ ] Euro countries  15 EUR

 [ ] Czech Republic 350 CZK  [ ] Poland          60 PLN
 [ ] Japan         1500 JPY  [ ] Switzerland     20 CHF
 [ ] Norway         120 NOK  [ ] USA             20 USD

DSJ4 Online: 3-Month Subscription

 [ ] Czech Republic 250 CZK  [ ] Poland          40 PLN
 [ ] Japan         1000 JPY  [ ] Switzerland     13 CHF
 [ ] Norway          80 NOK  [ ] USA             13 USD


DSJ4 Online: 12-Month Subscription

 [ ] Euro countries  20 EUR

 [ ] Czech Republic 500 CZK  [ ] Poland          80 PLN
 [ ] Japan         2000 JPY  [ ] Switzerland     25 CHF
 [ ] Norway         160 NOK  [ ] USA             25 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             : Mr. Jussi Koskela
     Bank               : Pohjola Bank Helsinki, Finland
     SWIFT (BIC) -code  : OKOYFIHH
     IBAN               : FI82 5132 0520 0464 34
     Bank account number: 513205-20046434



Date and Signature: ____________________________________

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Send orders and inquiries to us via mail or e-mail.

Mediamond Tmi
Nelikkotie 2 B 44
FI-02230 Espoo
FINLAND

E-mail: sales@mediamond.fi


We usually ship within 24 hours.