Order Form for
NetScan (SWREG
#1197001-NS)
BY FAX
To order by fax using a credit card, please print
out this document, complete it and fax to Soft Shop.
Following are our fax numbers - all are toll free
unless marked with a *.
If your country is not listed please fax to
the USA number +1 (978)
336 0331
Australia 1800
013971
|
Ireland
1800 509147 |
Spain 900 95
8968 |
Belgium 0707
03334* |
Italy
800 781703 |
Sweden 0207 94125
|
Finland 0925
360011* |
Netherlands
0208 845094* |
Switzerland
0800 835140 |
France
0800 917034 |
New Zealand
0508 555300 |
UK
08701331269* |
Germany
0800 1808295 |
Portugal 800
844030 |
USA or Canada
866 219 9380
(978) 336 0331*
|
BY PHONE
If you prefer you may phone the following numbers
and give your complete order - English Language only. When requested
for your card number do not tap it in but speak it. The product
code is shown as the SWREG# above.
If your country is not listed
below please call the UK number +44 1297552862
Australia 1800 069620
|
Norway 800 10772
|
Germany 0800 1808206
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Portugal 800 844031
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Ireland 1800 509145
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Spain 900 95 8969
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Italy 801 781702
|
Sweden 0207 96278
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Netherlands 0800 0232865
|
Switzerland 0800 835132
|
New Zealand 0508 555200
|
USA 866 500 6750
|
|
Ship-To Name
& Address:
First/Middle Name:
|
Last Name:
|
Company Name:
|
Address:
|
|
|
Phone + Fax:
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Your E-Mail Address - In Capitals:
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Card Number (MC, Visa, Amex, Discover, Switch,
Delta, Eurocard, Diner's):
|
Expires - Month: Year::
Start Date (Diners only):
Issue Number (Switch only):
|
|
Credit Card Holder's
Name & Address for Verification: Do NOT enter the BANK's name or address
in the fields below. Enter the address where the cardholder receives the
statements. (Only fill out the spaces below if the credit card holder's
name or address is DIFFERENT from the Ship-To Name and Address entered
in the spaces above.)
Name on the Card:
|
Company Name:
|
Address:
(if different to above)
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Order Details:
Item
|
Price
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Quantity
|
Subtotal
|
NetScan with Personal License
|
$12.95
|
|
|
Fax Handling Fee
|
$3
|
1
|
$3
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Total Order Amount in US Dollars
|
|
Card holder will pay card issuer above amount pursuant
to cardholder agreement
|
Signature: __________________________________
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We accept most cards including
Discover, JCB, Eurocard, Diner's Club, Delta, Switch, Visa, Amex,
Mastercard but we charge a 3% surcharge on Diner's Club
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