Application for LeapHeap Software Support

the details in this section will appear on the invoice
Name:.

Address:
.		.

in case we have a question about your application
Contact name:.
Contact email:.

your requirements
Date support is to start, or write "RENEWAL": .
Number of processors: .

calculating the cost
Unit price: 42 euro
Total price: euro
Volume discount, if applicable: %
Discounted price: euro
European Union customers add UK VAT @17.5% or (non-UK only) write your VAT number: euro
Final price: euro

this section for use only if not paying in euro
Alternative currency .
Exchange rate, 1 euro = .
Date that this exchange rate appeared on LeapHeap web site .
Final price in alternative currency .

I enclose a cheque for the above amount, payable to "Necklace Ltd"

Send your application to:
Necklace Ltd., 140 Faversham, Weymouth DT4 9SL, England

Necklace Ltd, registered in England and Wales number 3638819, registered address as above