Web Driver Order Form

Please fill out all required fields.  
Please print legibly.
You need only to return the bottom portion of this form.
Remember, you can also order on-line through www.winfiles.com

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Make checks payable to John Storta, Jr. and send to:
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John Storta, Jr.
4655 Hackberry Grove Circle
Charlotte, NC 28269
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The registration fee and address are subject to change in the future.

You should verify the address and the registration fee before mailing in this form.  You can do this by checking the web site at http://home.att.net/~visres

You only need to return the portion below this line.
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	***** Web Driver Order Form *****
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	Register Software To:
	Full Name:___________________________

	Ship To:
	Full Name:___________________________
	Address:________________________________________
	Address:________________________________________
	City:___________________________  State:____  Zip:_________-_____
	e-mail (optional):______________________________________________________
	Phone (optional):___________________________

	Quantity: ___________
	Price Per:______18.00 (this price includes tax and shipping)
	Total:_______________ (please include a check or money order for this amount)

	Make checks and money orders payable to John Storta, Jr.

	Send order form and payment to:
	John Storta, Jr.
	4655 Hackberry Grove Circle, #1613
	Charlotte, NC   28269

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