(address your cc statement is sent) | ||
| NAME: | ||
| Address: | ||
| Address: | ||
| City, State Zip: | ||
| Country: | ||
| Phone: | ||
| E-Mail Address: |
|
CD-ROM Price = $35.00 US Dollars
| |
| Quantity: ______ X $35.00 = | $_____________ |
| Shipments to the USA add: | $0.00 |
| Shipments outside USA add: | $5.00 |
| Grand Total = | $_____________ |
|
Payment Information: USA: You may pay by Personal Check if drafted in U.S. Dollars and from a U.S. Bank NON-USA Use: American Express World Wide Money Order drafted in U.S. Dollars Pay by Credit Card: ( Visa, MasterCard, American Express, Discover ) | |
| Credit Card Type: | Circle one: VISA MasterCard American Express Discover |
| Credit Card Number: | |
| Expiration ( month / year ): | |
| 3 digit code on back of card: | |
| Note: if your credit card statement address is different from your shipping address, please add your credit card address below or the card will be declined. | |
|
Send this form and Payment to:
Landofcom Software 17845 211th Ave. Big Lake, Minnesota 55309 USA |