Order Willow Pond Software by Fax

Order Willow Pond Software by Fax
hotel rooms HelsingborgNOTE: Willow Pond Software comes on CD only.

Print and completely fill out this form, then fax it to us along with your payment. If you prefer to pay by credit card, please provide us with the requested credit card information. Our fax number is below.

INCOMPLETE ORDERS CANNOT BE PROCESSED
PLEASE FILL OUT THIS FORM COMPLETELY
PLEASE PRINT CLEARLY

Please provide us with your e-mail address: ________________________

ORDERED BY				SHIP TO (Only if different from "ORDERED BY")
Name:	______________________________			Name:	______________________________
Street Address:	______________________________			Street Address:	______________________________
	______________________________				______________________________
City:	______________________________			City:	______________________________
State:	__________	Zip Code:	__________	State:	__________	Zip Code:	__________
Country:	______________________________			Country:	______________________________
Daytime Phone:	( ______ ) ______ - ________ x ____

Product	Quantity	*Unit Price	Amount (in US Dollars)
WillowTALK 2.5			$
WillowMEDIA 1.01			$
Subtotal			$
chambres d'hotel de luxe WaterfordAdd 5% Sales Tax			$
**Shipping/handling			$
Total Amount			$

    [_] Charge to my credit card. (Sorry, no C.O.D. orders)        (Visa or Mastercard only)

        Credit card number: ____________________________________________

        Expiration date (month/year): |________|-|________|

        Name on card: __________________________________________________

        Your signature: ________________________________________________

    * WillowTALK/WillowMEDIA unit pricing:        1-9: $39.95/unit WillowTALK, $29.95/unit WillowMEDIA      10-49: $27.95/unit        50+: $19.95/unit    ** Shipping/handling charges:        US/Canada:  $4.95/order    international: $12.95/order

Fax your order to:781-461-9681