Alberto Rodrguez Aragons. The Quimeras Company             Registration Form
Francisco Pizarro,3-2B                                     Fax: +34 639 118657
21003 Huelva, SPAIN                              e-mail: quimeras@quimeras.com
http://www.quimeras.com

Please complete the information below and mail or fax.
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Contact Name:     ____________________________ Company: ______________________

Shipping Address: ____________________________________________________________

                  ____________________________________________________________

Email Address:    ____________________________________________________________

Phone Number:     ____________________________ Fax Number: ___________________

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Product:                                          Select                 Price
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TqcRunas Company License for 10 users              [ ]                EUR   80
TqcRunas Company License for 25 users              [ ]                EUR  175
TqcRunas Company License for 50 users              [ ]                EUR  300
TqcRunas Company License for 100 users             [ ]                EUR  500
TqcRunas Company License for 250 users             [ ]                EUR 1000
TqcRunas Company License for 500 users             [ ]                EUR 1500
TqcRunas Company License for 1000 users            [ ]                EUR 2500
TqcRunas Company License for unlimited users       [ ]                EUR 3000

Total Enclosed:                                                 EUR __________

Notes: EUR 1 ~ USD 0.9
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Payment Method:	( ) Visa   ( ) Mastercard   ( ) Bank Order

Credit Card Number: ________________________________ Exp: ____________________

Name On Card (EXACTLY): ____________________________ PO Number: ______________

Signature: _________________________________________ Date: ___________________

=================================================================(06/06/01)===

If your company needs a formal offer, please ask for it to:
quimeras@quimeras.com

PRIVACY
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Alberto Rodriguez Aragones (The Quimeras Company or TQC) is firmly committed to
protecting the privacy of its customers and those who sample our products. TQC 
does not share, sell, or otherwise distribute the financial or personal 
information of its customers or those who otherwise provide personal information
to sample our products.

All financial and personal information collected by TQC is held in the strictest
confidentiality. Financial and personal information provided for orders is used
to process payment and to send order information to our customers.

More than anything, TQC tries to treat its customers as each one of us would like
to be treated. We value our privacy and we value yours, too. It is our goal to
make your experience with TQC a safe and positive experience.

For more information on TQC's privacy policy, please feel free to contact us at:
quimeras@quimeras.com
