Hemodynamics AG
Surbekstrasse 39, P.O. Box 668,
CH-3000 Berne 31
Switzerland
Fax: +41 31 941 3836              Phone: +41 31 941 3830

Order for Activation Code of TCD Simulator Professional Version 2.3          

Serial Number of TCD Simulator :  _ _ _ _ _ _ _ _ _ _ _ _

Name ............................................................................

Address ........................................................................

........................................................................................

Postal Code (Zip) ........................ City/Town ........................................

Country ......................................... E-mail ...............................................

Phone ........................................... Fax ...................................................

□  TCD Simulator Version 2.3 Professional ........... CHF  76.00

□  3-D cardboard glasses (will be sent by mail)....... CHF     8.00

Total:                                           ................................................................

(All prices in Swiss Francs - CHF)

Payment Method:

□ Visa   or   □ Euro/MasterCard No:.....................................................

Exp. Date (month-year) ...... -....... Exact Name on card: ......................................

□ Check or International Money Order for _____________ is included

□ Bank transfer (for account information see below)

Date: ........................................ Signature: ..............................................................

Hemodynamics AG Bank Account:
Credit Suisse Bern IBAN  CH03 0483 5031 2795 4100 1    Swift code (BIC): CRESCHZZ30A