NetCulture - Virtual Domain (FPV1.4)
Request for Addition or Removal of FrontPage Extensions

Please can you make the below indicated modifications to our virtual domain account for the Microsoft FrontPage extensions. This complete document should be then either faxed through to NetCulture on +33 (0)1 4035 3194 , or sent via normal post to NetCulture, 18 pl de la Chapelle, 75018 Paris, France.

Name : ________________________________
E-Mail : ________________________________
Company : ________________________________ if applicable
VAT or Registration Number: ___________________________ if applicable
Address : ________________________________
City : _____________________ Postcode: _____________________
Country : ________________

Telephone :

_____________________ Fax: _____________________


Domain name :


________________________ e.g. 'yourcompany.com' or 'yourcompany.fr'
Admin account : ________________________


Quantity Description
Price

[___]

Installation of FrontPage Extensions

30.50

[___]
Removal of FrontPage Extensions 30.50
Total ______
VAT @ 19.6% ______ Zero ONLY if applicable ! see below
Total Amount Payable ______


IMPORTANT: Companies registered for VAT who are outside France but within the European Community should indicate their VAT or company registration number above. In this case the VAT may be ZERO rated.
Companies outside the EEC come under 'export' where VAT is not applicable.


Visa or MasterCard

[___] Please charge my normaly used Visa or MasterCard for the amount shown above.

Cheque (French Only)

[___] I enclose a cheque made payable to NetCulture for the amount shown above.