ETN Card On-Line Order Form
Order Form for Fax and Regular Mail

Family Name:
Initials:
Company Name: Optional !
Position: Optional !
Profession: Optional !
Street / P.O.Box:
City + State:
Country:
Postal / Zip Code:
Telephone Number: incl.Country + Area Code
Fax Number: incl.Country + Area Code
E-Mail:
Home Page URL: Optional !

orders hereby the following ETN Card(s):

Name as wanted on your ETN Card(s):

NAME as wanted on FIRST ETN Card
NAME as wanted on SECOND ETN Card

Form of Payment

 I pay as follows:


the following TOTAL amount:

Cheques and Cash must be sent by REGISTERED MAIL to:
ETN Head Office, P.O.Box 561
NL-5600 AN Eindhoven - Holland.

Credit Card Information (Visa - MasterCard - Eurocard)
  1. ETN only accepts credit cards of Eurocard, MasterCard and Visa.
  2. ETN realizes that you may not be comfortable in sending your credit card info via Internet.
    That's why you can send your card number in one of the following ways:
    • Call Charlie, our 24-hour English speaking computers:
      Dial in the USA 1 - 310 - 507 0129 or in Holland 31 - 73 - 547 9759
      and give your Name, credit card number and credit card expiry date.
    • Credit Card Secure Send
    • Send EACH block of 4 digits in REVERSE order below !!
      EXAMPLE: Your credit card number is: 1234 5678 9123 4567
      Below you give your credit card number as: 4321 8765 3219 7654
    • Send your Name, credit card number and credit card expiry date by fax to: 1 - 310 - 507 0129 in the USA OR 31 - 73 - 543 0117 in Holland
    • Give your credit card number by phone to:
      Holland 31 - 73 - 547 9759 (9 - 21 h. GMT)
      ETN Card Order Form for Fax and Regular Mail

Inform ETN how you send your credit card number:

Credit Card COMPANY
Credit Card NUMBER4 x 4 digits !
Expiration Date mm/yy
Name Credit Card holder

Remarks, Comments and Questions



Click here to send your ETN Card Order:



If NOT succesfully sent, click this button:

ETN Home Page