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Text File  |  1998-04-15  |  4KB  |  79 lines
  1. Please print this form and follow the instructions below:
  2. ---------------------------------------------------------------------------
  3.                           DDH Software Order Form
  4.                         Email, Mail, Fax, or Phone to:
  5.  
  6.                                [DDH Software]
  7.                             ATTN: David Haupert
  8.                                PO Box 970971
  9.                           Boca Raton, Fl 33497-0971
  10.                                (561) 470-2133
  11.                          email: sales@ddhsoftware.com
  12.                         web: http://www.ddhsoftware.com
  13. ---------------------------------------------------------------------------
  14. First Name:____________________      Last Name:____________________________
  15.  
  16. Street: _____________________________________________________________
  17.  
  18. City:________________________________________________________________
  19.  
  20. State:____________________ Zip Code:___________ Country:_____________
  21.  
  22. Day Phone: _______________________  Eve Phone:_______________________
  23.  
  24. Email address:_____________________________________________
  25.  
  26. Choose Payment Option:
  27. [ ] *Check or *Money Order (enclosed)  [ ] First Virtual  [ ] Credit Card
  28. * Please make payable to: David Haupert
  29.  
  30. Choose one shipping option:  [ ] Via Email      [ ] Via Mail (*US Only)
  31.  
  32. If Registering by First Virtual: Pin #: __________________________________
  33.  
  34. If Registering by Credit Card: Check one:  [ ] Visa    [ ] MasterCard
  35.  
  36. Account Holder full name (as it appears on card): _________________________
  37.  
  38. Credit Card Account #:  ___________________________________________________
  39.  
  40. Expiration Date (MM/YY): ___/___
  41.  
  42. Product(s): Enter the Quantity of each item you would like to register:
  43. ----------------------------------------------------------------------------
  44. Quantity Description                     # Words      Price (US $)   Total
  45. ____     Translate + Danish Language     3787/4062        $12.00     $
  46. ____     Translate + Dutch Language      8633/19109       $12.00     $
  47. ____     Translate + Esperanto Language  8665             $12.00     $
  48. ____     Translate + Finnish Language    3228             $12.00     $
  49. ____     Translate + French Language     7135/9055/12341  $12.00     $
  50. ____     Translate + German Language     9335/17140       $12.00     $
  51. ____     Translate + Hungarian Language  1200             $12.00     $
  52. ____     Translate + Icelandic Language  1106/1274        $12.00     $
  53. ____     Translate + Indonesian Language 1155             $12.00     $
  54. ____     Translate + Italian Language    2275/3526/4504   $12.00     $
  55. ____     Translate + Japanese Language   1806/9752/2577*  $12.00     $
  56.          *Shipped with free larger EDICT_S database
  57. ____     Translate + Latin Language      745/1739         $12.00     $
  58. ____     Translate + Mandarin Language   1491/1834        $12.00     $
  59. ____     Translate + Norwegian Language  1936             $12.00     $
  60. ____     Translate + Portuguese Language 2353/3338        $12.00     $
  61. ____     Translate + Spanish Language    3666/8083/11663  $12.00     $
  62. ____     Hangman + Wheel of Treasure     N/A              $12.00     $
  63. ____     Thesaurus                       52,255           $15.00     $
  64. ------------------------------------------------------------------------------
  65.                                                 Subtotal             $
  66.                                                 Less any Discount  - $
  67. ------------------------------------------------------------------------------
  68.                                                 Total amount         $
  69.  
  70. I authorize David Haupert to charge the appropriate amount as noted above
  71. for providing the appropriate software as listed above.  Software will be
  72. shipped or emailed as noted above.  I understand that the software is
  73. released as shareware and it is protected by copyright from illegal use
  74. and/or copying.  I also understand that the software is released as is, and
  75. that author is not responsible for any damages that may occur from the use
  76. or misuse of this software.
  77.  
  78. Signature:_________________________________________ Date:______________
  79.