ORDER FORM

Please use this form to order Molecular Movies 2 (english school licence version).
Fill in the form, print it, and mail it to the adress below (if your organization requires a P.O., please include the PO number). You will recieve an e-mail with downloading instructions and an attached invoice. A backup CD with Molecular Movies 2 will also be be mailed to you.

Adress for corrspondence:

ChemLibris c/o Norberg
Brötvägen 24
SE-167 66 Bromma
SWEDEN


I hereby order   copies of Molecular Movies 2 (english school licence version)

price: Amount of licenses ordered x USD 150:-
freight (USD 3:-):
bank transfer charge* (USD 7:-):
TOTAL AMOUNT DUE (USD)
* only if the "bank wire transfer" payment method is selected
Name:
School/Company:
Street/Box address:
City: Zip code:
State: Country:
e-mail: P.O. n:o

Date.....................Signature ................................................

PREFERRED PAYMENT METHOD:
Bank wire transfer US Check Other (indicate)