ORDER FORM

Please PRINT legibly
   
Your Name: __________________________________________________
Email Address: __________________________________________________
Company: __________________________________________________
Address: __________________________________________________
City, State, ZIP: __________________________________________________
Country: __________________________________________________
Phone / Fax: _______________________  /  ________________________
   
Course

Price
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Credit Card Type: [  ] Visa    [  ] MasterCard   [  ] Discover   [  ] Check / Money Order
Credit Card Number: _________ - _________ - _________ - _________
Expiration Date: _________ - _________
Signature: __________________________________________________
   
Merchandise Total: $ ___________.____
Shipping & Handling: $   9.95
Sales Tax (8.75%): $ ___________.____   New York State Residents Only
ORDER TOTAL: $ ___________.____   US DOLLARS
   
 
     
 
Mail your order to:
599CD ORDERS
Amicron Computing
3380 Sheridan Drive, Suite 259
Amherst NY 14226 USA
 
     
 

By placing your order, you acknowledge that you have read and agree to our
license agreement and terms of sale located at http://599cd.com/license.asp.