This order form is for CREDIT CARD AND USA CHECK ORDERS 
SENIOR CITIZENS ONLY - OVER 60 Years of age
(contact us here if need other options) 
Examples: VISA/Master/Discover/Amex orders 
and USA Check orders.

* means this item is required to process your order.

How did you hear of us?
*Your First Name ------>
*Your Last Name  ------>

If this is to be registered in another person's name 
(as if you are buying them a gift)
then put their name here as the software will 
be registered in their name and their address:
Other person's First Name 	
Other person's Last  Name 

Company Name---> (optional)
*Street Address->
*City----------->
*Province/State->
*Zip/Postal Code>
*Country-------->
*Your Age (required)

*Complete Telephone Number (including country and area code) 


*E-Mail address->

I have or will download the software on the internet (do not send disks or CD)I NEED you to send me CDROM of the software (I've added the extra $)(choose 1)
(Note:You can create the old floppy disks from the 
CDROM or website if needed)

PRICES: US Dollars (Note:One copy has to be purchased per computer)
Click here for information about regular version or network version
SENIOR CITIZENS ONLY - OVER 60 Years of age
Quantity                Regular Version      Network Version
Quantity 1 (first copy) $ 30.00              $40.00
Additional copies       $ 20.00 each.        $30.00 each.
DEMO on CD only         $  5.00              $ 5.00

I am ordering      registration code  at $
and an additional  registration codes at $ each.
Additional copies are for you only within your company 
or personal use. You can not order additional copies for 
friends for discounted rates as each additional copy 
is registered under your name only.
Note: One registration code per computer.   
The registration code will unlock the demo copy 
to a FULL Version and unlock the CD-ROM version 
if you are ordering a CD-ROM.

Payment Information---------------------------------------------------

I will be paying by United States CheckVisa Credit CardAmerican Express Credit CardMastercard Credit CardDiscover Credit CardDIRECT WIRE TRANSFER bank to bankDoes Not Apply

If payment is by credit card enter credit card 
information below:
Enter the card number here 
Expiration Date            
Exact Name on credit card  
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If you picked DIRECT WIRE TRANSFER as payment method, 
please see the bottom of this form for additional instructions

Custom Database Conversion Charges------------------------------
(only fill this in if you paid custom conversion charges 
to convert your current database to our format)
As quoted by you, I agree to pay an additional US $  
for customization of mdb2000 or conversion of my current 
database into MDB2000 format which is the same as 
(Microsoft Access 7.0 format - Access 97) Custom versions 
of mdb2000 require a separate email describing 
your needs prior to filling out this order form so 
that you can put the proper $ amount in the box
above.
-----------------------------------------------------------------

CD-ROM Option
I have added $5.00 above to the price 
as I need A CD-ROM copy of the software.

Shipping Destination (if not USA)
I have added $5.00 for shipping to NON-USA address

Minnesota Residents
I live in Minnesota USA and please add 
6.5% sales tax of $ dollars.

IF you have a Certificate or Rebate Number 
please enter it here 
(if you don't know what this is...
then it does not apply to your order)

If paying by check---allow 7-10 days after 
we receive your check for us to ship
your software. Send checks to the address 
at the bottom of this page.

The total amount I will be 
paying you is $ US dollars.  
(please include all additional charges above that may apply)

You agree to the above by clicking on the button below.

 

NOTE: Your machine's ID # is sent in 
encrypted form to us so we can 
verify you are the credit card holder 
and you are the sender of the e-mail.

REMEMBER if you don't want to send your 
info over the Internet you can 
PRINT this form or call us at 1-866-688-9600 TOLL FREE
Phone orders are processed within 1-2 days.  
Internet orders-same day.

Thank you!