ETN CARD ORDER FORM for Fax and Regular Mail (to be printed)
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Send this completed Order Form with your payment by Fax to 
to  31-73-543 0117 in Holland  OR
by Regular Mail (ETN, P.O.Box 561, NL-5600 AN Eindhoven - Holland)

YES, SEND THE FOLLOWING ETN CARD(s) (circle what's applicable)
(A same second ETN Card can be ordered behind Point 9 for US$ 10 EXTRA)

A.  One-Year Worldwide Card valid thru June 2000 for US$ 69

B.  Three-Year Worldwide Card valid thru Dec.2002 for US$ 149

TO THE FOLLOWING ADDRESS:

1.  Name:

2.  Street/P.O.Box:

3.  City, State:

4.  Country + Postal/Zip Code:

5.  Telephone:                           6. Fax:

7.  Email:

8.  NAME as wanted on the ETN Card:

9.  NAME on SECOND ETN Card (US$ 10 EXTRA):

METHOD OF PAYMENT (MasterCard/Visa, Cheque/Cash, Bank Transfer)

10.  Credit card number (4 x 4 digits):

11.  Credit card expiry date (mm/yy):

12.  Credit card holder's name:
   
13.  Credit card holder's signature:

14.  Cheque or Cash to be sent to: ETN, P.O.Box 561,
                                   NL-5600 AN Eindhoven - Holland
     Please make cheques payable to European Travel Network