Registratieformulier voor OziExplorer

Europe
share-it! - Digital River GmbH
c/o Digital River Ireland Ltd.
Unit 153
Shannon Free Zone West
Shannon Co. Clare
Ireland

Phone: +49 221 31088-20
Fax: +49 221 31088-29

USA
share-it! - Digital River GmbH
c/o Digital River Inc.
9625 West 76th Street, Suite 150
Eden Prairie, MN 55344, USA

Phone:  +1 800 903 4152 (for calls from inside the U.S.)
            +1 952 646-5747 (for calls from outside the U.S.)
Fax: +1 952 646-4552

Please register the above program to / Gelieve bovengenoemd programma te registreren aan:

Achternaam / Last name:

Voornaam / First name:

Bedrijf / Company:

Straat&nummer / Street and #:

Postcode&woonplaats / City, State, postal code:

Land / Country:

Telefoon / Phone:

E-Mail:

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____________________Fax: _________________

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Kaarthouder / Card holder:

Kaartnummer / Card No.:

Vervaldatum / Date of Expiration :

Datum/Handtekening / Date/Signature:

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