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Funduc Software, Inc. - Fax and Mail Order Form

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Funduc Part Number: 286-SR-2500 (32-bit) or 286-SR-2564 (x64) (Circle One)

Fax Orders:

Fax to the number indicated on the page at
www.funduc.com/contact.htm

Check Orders:

Funduc Software, Inc.
P.O. Box 530904
Livonia, MI 48153-0904
USA

——– PRINT NEATLY OR TYPE! ——–

Single user

$ 25.00

_______

$________

2 to 9 users

$ 23.00

_______

$________

10 to 24 users

$ 21.00

_______

$________

25 to 49 users

$ 18.00

_______

$________

50+ users

$ 15.00

_______

$________

Residents of Michigan, United States – add 6% sales tax

$________

Preferred Shipping Method Disk (USPS Domestic US) $8.00 S&H

$________

Disk (USPS International) $10.00 S&H

$________

Email/e-Delivery (Free)

$___ 0 ___

TOTAL PAYMENT

$________

Credit Card Information

Card Type (Check One):

Visa[ ] American Express[ ] MasterCard[ ] Discover[ ] 

Name as it appears on card:

____________________________________________________

Credit Card Number:

____________________________________________________

Expiration Date:

____________________

Street Address:

____________________________________________________

Street Address:

____________________________________________________

City, State Zip:

____________________________________________________

Country:

____________________________

Your Information (Write ‘Same’ if not different from above)

Your Name:

____________________________________________________

Company:

____________________________________________________

Street Address:

______________________________________
______________

Street Address:

____________________________________________________

City, State, Zip:

____________________________________________________

Country:

____________________________________________________

Day Phone Number:

____________________________

Fax Number:

____________________________

Alt Phone Number:

____________________________

* EMail Address:*

____________________________________________________

Signature:

____________________________________________________

Date:

____________________________