4DiskClean Gold Order Form   

Delivery is done through a vendor generated registration code that 
will be sent to you via email within 48 hours. 
Register Code will be sent in the name of user,or in company name
(multiuser license).
                       
Ordering Methods

Telephone Orders $3.00 each
Mail and Fax Orders $2.50 each 

Telephone 
Toll Free: 877-353-7297
Regular (International): 425-392-2294 

Fax 
Toll Free: 888-353-7276
Regular (International): 425-392-0223 

Paying by Check via Postal Mail 

Make sure to makes check out to "Register Now!".
mail checks to: 

  Register Now!
  Dept# 2186-2
  PO Box 1816
  Issaquah, WA 98027
  United States of America 
                        
For international checks, we would prefer the funds be drawn in US 
dollars. When this is not possible, we will accept checks for a 
corresponding amount in the country's currency. 
Unfortunately, Eurochecks are not accepted. 

Purchase Orders 
A purchase order must be faxed or mailed to us with all necessary
information including billing information.                         
                                                                                              
                                             
                                                                
    


                                       
Product id:  2186-2   4DiskClean Gold
                                     
First Name:- -----------------------------------------------------
                                                                     
Last Name: -------------------------------------------------------
                                                                         
Company: ---------------------------------------------------------
                                                                         
Billing Address: -------------------------------------------------
                                                                        
City: ------------------------------------------------------------
                                                
State/Province: --------------------------------------------------
                                                
Zip/Postal Code: -------------------------------------------------
                                                
Country: ---------------------------------------------------------
                                                                 
Phone: -----------------------------------------------------------
                                                                         
Email Address: -------------------------------------------REQUIRED                                                            

Order Information 
 Quantity:  1: (   ) 1 User License   
            5: (   ) 1 Company License (50 users).    

 Price:        (   )  $  24.00   = 1 User license.
               (   )  $ 120.00   = 1 Company license.

Extras:      (   )  + $ 2.50  tax ,for fax orders.   
all prices in american dollars.     
                     
Payment Information
Name on Card: ----------------------------------------------------
                                                                         
Type of Credit Card:     
  (   ) VISA         (   ) MASTERCARD   (   ) AMERICAN EXPRESS   
  (   )  DISCOVER(NOVUS)   (   ) EUROCARD
                                            
Card Number: ------------------------------
                                            
Expiration Date: -----/----/----

Month ------   Year(4 digits)  ----/----/-----