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Print This Page | |
| -------------------------- printout this order form, then fax (or e-mail) ---------------------------------------- | ||
2689 Danforth Terrace, Wellington FL 33414
tel.(561) 792-1477 fax: (561) 792-1677
Credit Card Charge Authorization Form
Your Company Name: _______________________________________________________
Your Phone Number: _______________________ Contact Name: ___________________
(We will call you to confirm shipping information.)
| Charge Date: | __________ |
| Description: | Visual SupplyPro Software |
| Includes: 60 Days Free Support, Training, Updates, Bar Code Scanner. Data Conversion Services are available, call for pricing. |
|
| Select License Type (place check in box): | |
| [ ] $895 (US$)- Multi-User, Single Location License | |
| [ ] $299 (US$)- Additional 1-year support, training, program updates | |
| (multi-location licenses are available; call for details) | |
| Amount: | |
| Add Shipping | $15.95 S/H to U.S. or Canada |
| & Handling | $89.00 international |
| Total: | (US$) |
| Credit Card: ___AMEX ___Visa ___MasterCard Card Number: _____________________________________ Exp.Date: ______mm/yy Name on Card:________________________________ 3-digit code on back ______ Billing Address:__________________________________________________ City, State : _________________________________ ZIP:_______________ CC Signature: ______________________________ Date: ______________ X I Authorize Decision Software Systems, Ltd. to charge the amounts listed above to the credit card listed |
Thank You for Your Order!
Please Fax Back to DSS @ (561) 792-1677