| Fax to |
| 713-524-6398 |
| Mail to |
|
PsL PO Box 35705 Houston TX 77235-5705 |
PsL Order FormV - The Win32 File ViewerItem #30114 |
....... 2-9 users @ $20 each ....... 50-99 users @ $11 each ....... 10-24 users @ $17 each ....... 100-499 users @ $8 each ....... 25-49 users @ $14 each ....... Unlimited License - $4,000Total value of order $________
[All amounts are in $US] [Residents of Texas must include the relevant sales tax]
Name (First/Last) ......................................................
Company name ......................................................
(if applicable)
Address ......................................................
......................................................
City ......................................................
State/Province .................... Zip/Post Code .................
Country ......................................................
Email address ......................................................
Contact Phone # ......................................................
Registered User Name .................................................
(This is the name that will appear on the About Box)
Credit card number (MC, Visa, Amex, Discover) ............................................. Expiration Date (MM/YY) ............ Signature .............................................
Name on Credit Card ......................................................
Company name ......................................................
(if applicable)
Address ......................................................
......................................................
City ......................................................
State/Province .................... Zip/Post Code .................
Country ......................................................