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               BETHEL INGENIERIA. Fax/Mail Order Form
 ________________________________________________________________________
 Note:
 Please fill out the order form below and return with a check or 
 international money order (in U.S. dollars), payable to Bethel Ingeniería.  

 Please visit www.betheling.com for pricing. 


 Courtesy []Mr. []Ms. 

 First name   __________________________________________________

 Last name   __________________________________________________

 Email Address_________________________________________________

 Phone _________________       Fax  number _______________________

 Organization  _________________________________________________

 Street Address ________________________________________________	

 Postal Address _______________________________________________ 

 City  __________________________ 	

 State/Province  _______________________  Country ________________	


 Signature________________________

 Today's date: ____________________


 Product Details
 In the spaces provided below please include the serial number and program
 code for each installed trazar copies where you wish to obtain regular 
 Trazar licenses.  

   Serial number          Program Code        
 1. _____________    ______________________    
 2. _____________    ______________________     
 3. _____________    ______________________    
 4. _____________    ______________________     
 5. _____________    ______________________    

 Total Quantity (units): __ 	Total Payment  US$ _______.

 (Note: Bethel Ingenieria confirms the receipt of the order by a confirmation email.
 Registered users will receive an authorization code by email).

 CONTACT INFORMATION
 Customer information is considered confidential and will not be shared with 
 or distributed to any third party.

 Mail the completed form to:

	Bethel Ingeniería,
	0819-02763
	Republic of Panama.

 Tel: (507) 253-0662 FAX: (507) 253-0662
 Email: sales@betheling.com
 Website: http://www.betheling.com
 ____________________________________________________________
 Last Edited: March 2009
