Avenger 1.0a Credit Card Order Form

ORDER INFORMATION


When ordering by phone, FAX, e-mail, or regular postal mail, you must
provide the following information.  If you are paying by check or
money order, you do not need to provide credit card information:

Your Name:

Billing Address (the address your credit card bill is sent to)
 Street:
 City:
 State:
 Zipcode:
 Country:

Mailing Address (if different than billing address)
 Street:
 City:
 State:
 Zipcode:
 Country:

Home Phone Number:
Work Phone Number:
E-mail Address:

Credit Card Information
 Type (Visa, Mastercard, American Express)
 Account Number:
 Expiration Date:

Software to Order
 Title:
 Quantity:
 Total Dollar Amount:

If FAXed or e-mailed, please include the following language (and sign
if FAXed):

I authorize AXXIS(TM) Internet to bill my credit card and agree to pay
the total amount according to card issuer agreement.

_________________________       _____________
Signature                       Date

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		      ALTUS SOFTWARE MARKETING
			www.axxis.com/altus/