Fax to |
910-350-2937 |
Mail to |
BMT Micro PO Box 15016 Wilmington NC 28408 |
BMT Micro Order FormV - The File Viewer
|
....... 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 North Carolina 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 # ......................... Fax# ...................... 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 ......................................................