SecureFX Student Order Form
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To qualify for student pricing, you must currently be registered 
as a student.  Please send us:
  - A copy of your student ID or current class schedule
  - A completed order form
  - A check or money order for $20.00 (U.S.)

Payments must be in U.S. dollars drawn on a U.S. bank.

Please mail your order to:

  VanDyke Software
  4848 Tramway Ridge Dr. NE, Suite 101
  Albuquerque, NM 87111  USA

 
SecureFX Student Price                                   $20.00

New Mexico Residents add 7.00% sales tax               + ______

                                 Total payment           ______

Prices are subject to change. Please refer to http://www.vandyke.com
for current pricing.

 - No disk will be sent with your order.


                      --- Please Print ---

This Software is subject to export control and may be transmitted, 
exported, or re-exported only under applicable export laws and 
restrictions and regulations of the United States Bureau of 
Industry and Security or foreign agencies or authorities. 

Please answer this question.

[ ]Yes  [ ]No  Do you acknowledge affirmatively that you understand
               that the requested software is subject to export
               controls under the Export Administration Act and 
               that you may only export or re-export the software 
               under the laws, restrictions and regulations of the  
               U.S. Bureau of Industry and Security or foreign 
               agencies or authorities?


Signature: ________________________________________________________

Name: ________________________________________  Date: _____________

Company: __________________________________________________________

Shipping Address: _________________________________________________

City, State, Zip: _________________________________________________

Country: _______________________ Phone Number: ____________________

E-Mail Address: ___________________________________________________

Would you like to receive update announcements by e-mail? _________

How did you hear about SecureFX? __________________________________

Comments: _________________________________________________________

          _________________________________________________________

___________________________________________________________________

SecureFX is a registered trademark of VanDyke Software, Inc. 
in the United States and other countries.