|
RegSoft.com FAX Registration |
|
Please fill in the form below Completely, print it out, and FAX
it to 770-497-9234 |
|
If you choose to fill it out by hand PLEASE PRINT LEGIBLY
|
|
10:25:28 8/10/99 - 24.200.83.213
|
| Product ID |
15058 |
| Program Name |
Desks At Will |
| Registration |
$22.50 |
| Quantity |
|
| Billing Information: |
Email Address:
If
this field is left blank
you order may not be processed |
|
Name:
as it appears on credit
card |
|
Company Name:
(optional) |
|
Address:
Exactly as it appears on
your statement
(please include the COUNTRY) |
|
| Georgia Residents are required
to add Sales Tax - Please select your County |
| Phone Number: |
|
| CC Type: |
Visa
MasterCard
American Express
Discover (Novus) |
| Credit Card Info : |
Exp Date
|