I have read the Software License Agreement and agree to its terms. Please send me ____ software licenses for Gravity Well at just $29.95 each. Add $3.95 to pay for shipping & handling. Please add 3.5% sales tax to deliveries to Colorado. Quantity orders of ten or more may deduct 10% from the licensing cost.
Today's Date: __/__/__
Software Version:_____
Company:_______________________________________
Name:__________________________________________
Address:________________________________________
_______________________________________________
_______________________________________________
Phone:__________________________________________
Fax:____________________________________________
E-mail:__________________________________________
Credit Card Information: Master Card ___ Visa ___
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date: ___/___
Name (As it appears on the card)
_________________________________________
Signature_________________________________________
Enclosed is my payment to:
Amount enclosed $__________
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