Printable Order Form Easy to Print and Mail or Fax! Just type in the fields below, then Please select your product or service here: 5 Additional Web Pages $25.00/yr Enter your Member User Name/Password User Name: Password: Edit or Delete a Web Page $25.00 Enter your Member User Name/Password User Name: Password: Page Name: Software on CD rom Includes: 650 Reports, Fillout Manager, Short Keys, KeyBoard Express, and ClipBoard Magic. CD+Shipping/Handling Charge: $12.00 delivered via Priority Mail Enter your Member User Name/Password User Name: Password: SHIP TO Name: Address: City, ST, ZIP Other: Check this box and explain if we had already agreed to perform "other" work or service for you. Enter Amount Here Email Address: BILLING INFORMATION I'm Paying by Check or Money Order Enclosed If paying by Credit Card, please complete the below information: Name on Card: Credit Card Type Visa Mastercard Amex Discover Credit Card Number Expiration date: Month: Year: Card billing information - (Must match where your statement is sent to) Street address: City: State: - Live outside of the USA ? put ' ZZ ' in this field Zip Code: Country: Day Phone: ( required for security purposes only ) Eve Phone: Fax Phone: Please submit this order form by Phone, Fax, Or Snail Mail: By Phone: Call (805) 474-8735 By Fax: (805) 474-8735 Snail Mail: Tri-Tek Inc. P.O. Box 330 Arroyo Grande, CA 93421 USA Thank you!
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