Please print this form and follow the instructions below: --------------------------------------------------------------------------- DDH Software Order Form Email, Mail, Fax, or Phone to: [DDH Software] ATTN: David Haupert PO Box 970971 Boca Raton, Fl 33497-0971 (561) 470-2133 email: sales@ddhsoftware.com web: http://www.ddhsoftware.com --------------------------------------------------------------------------- First Name:____________________ Last Name:____________________________ Street: _____________________________________________________________ City:________________________________________________________________ State:____________________ Zip Code:___________ Country:_____________ Day Phone: _______________________ Eve Phone:_______________________ Email address:_____________________________________________ Choose Payment Option: [ ] *Check or *Money Order (enclosed) [ ] First Virtual [ ] Credit Card * Please make payable to: David Haupert Choose one shipping option: [ ] Via Email [ ] Via Mail (*US Only) If Registering by First Virtual: Pin #: __________________________________ If Registering by Credit Card: Check one: [ ] Visa [ ] MasterCard Account Holder full name (as it appears on card): _________________________ Credit Card Account #: ___________________________________________________ Expiration Date (MM/YY): ___/___ Product(s): Enter the Quantity of each item you would like to register: ---------------------------------------------------------------------------- Quantity Description # Words Price (US $) Total ____ Translate + Danish Language 3787/4062 $12.00 $ ____ Translate + Dutch Language 8633/19109 $12.00 $ ____ Translate + Esperanto Language 8665 $12.00 $ ____ Translate + Finnish Language 3228 $12.00 $ ____ Translate + French Language 7135/9055/12341 $12.00 $ ____ Translate + German Language 9335/17140 $12.00 $ ____ Translate + Hungarian Language 1200 $12.00 $ ____ Translate + Icelandic Language 1106/1274 $12.00 $ ____ Translate + Indonesian Language 1155 $12.00 $ ____ Translate + Italian Language 2275/3526/4504 $12.00 $ ____ Translate + Japanese Language 1806/9752/2577* $12.00 $ *Shipped with free larger EDICT_S database ____ Translate + Latin Language 745/1739 $12.00 $ ____ Translate + Mandarin Language 1491/1834 $12.00 $ ____ Translate + Norwegian Language 1936 $12.00 $ ____ Translate + Portuguese Language 2353/3338 $12.00 $ ____ Translate + Spanish Language 3666/8083/11663 $12.00 $ ____ Hangman + Wheel of Treasure N/A $12.00 $ ____ Thesaurus 52,255 $15.00 $ ------------------------------------------------------------------------------ Subtotal $ Less any Discount - $ ------------------------------------------------------------------------------ Total amount $ I authorize David Haupert to charge the appropriate amount as noted above for providing the appropriate software as listed above. Software will be shipped or emailed as noted above. I understand that the software is released as shareware and it is protected by copyright from illegal use and/or copying. I also understand that the software is released as is, and that author is not responsible for any damages that may occur from the use or misuse of this software. Signature:_________________________________________ Date:______________