This order form is for CREDIT CARD AND USA CHECK ORDERS 
(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.

*Your First Name ------>
*Your Last Name  ------>

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

*Complete Telephone Number (including country and area code) 


*E-Mail address->

DOWNLOAD OR CDROM OPTION (CLICK ONE TO HIGHLIGHT IT)
I have or will download the software modifications via Internet (do not send disks or CD)I NEED you to send me CDROM of the software (I've added the extra $)

PAYMENT is in US Dollars for software programming and conversions.

Custom Database Conversion Charges------------------------------
(only fill this in if you paid custom conversion charges to convert
 your current database or modify the program for special use)
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 version 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.
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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

If paying by check---allow 7-10 days after we receive your check for us to ship
your software or email it. 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)

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

I will be paying by Visa Credit CardAmerican Express Credit CardMastercard Credit CardDiscover Credit CardUnited States CheckInternational Check (add 5.00) to your order.Does Not Apply
If payment is by credit card enter credit card
Enter the card number here 
Expiration Date            
Exact Name on credit card  
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You agree to the above payment and agree to the cardholder terms if paying
by credit card.

 

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.

Thank you!