Engen Petroleum Limited - AMS Enrollment Form
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Auxiliary Mailing Service Enrollment Form Benefits · Privilege of ordering licenses directly from HTRI · Option to receive one single user hardware key or up to three (3) software single user licenses · Option to order an unlimited number of additional hardware keys and software licenses at the fees listed in the product order form Annual Fee · US$650 per year plus cost of additional products ordered and shipping charges Enrollment · Verify the contact information listed below. If everything is correct, return the signed form to HTRI. 1. Billing and Shipping Information Company Name: Engen Petroleum Limited Street Address: 456 Tara Road Street Address: City, State, Zip Code: Wentworth, Durban, 4052 Country: South Africa Email: [email protected] Contact Person: Krishna Govender Fax: + Telephone: + 27-31-460-3504 Technical Advisory Committee (TAC) representative Printed Name Date AMS contact Printed Name Date 2. Approval Signatures Return completed form to [email protected] Rev. 20134017
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Engen
Transcript of Engen Petroleum Limited - AMS Enrollment Form
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Auxiliary Mailing Service Enrollment FormBenefits
Privilege of ordering licenses directly from HTRI Option to receive one single user hardware key or up to three (3) software single user licenses Option to order an unlimited number of additional hardware keys and
software licenses at the fees listed in the product order form
Annual Fee US$650 per year plus cost of additional products ordered and shipping
charges
Enrollment Verify the contact information listed below. If everything is correct,
return the signed form to HTRI.
1. Billing and Shipping Information Company Name: Engen Petroleum Limited Street Address:
456 Tara Road Street Address:
City, State, Zip Code: Wentworth, Durban, 4052
Country: South Africa Email: [email protected]
Contact Person: Krishna Govender
Fax: +
Telephone: + 27-31-460-3504
Technical Advisory Committee (TAC) representative Printed Name Date
AMS contact Printed Name Date
2. Approval Signatures
Return completed form to [email protected]
Rev. 20134017
