Bill To / Card Holder Information (Must match
exactly)
*Required
Fields
Company*
_____________________________________________________________
First Name* _______________________ Last Name* _________________________
Address* _____________________________________________________________
Address _____________________________________________________________
City* ____________________________ State* _________________________
Postal Code* ___________________________ Country* _______________________
Phone #* ____________________________ Fax # __________________________
E-Mail*
_____________________________________________________________
Activation code(s) will be sent to this email address.
Method of Payment (Check one)
____ Credit Card ____ Visa ____ Mastercard ____ Amex
____ Discover
Card # _______________________________________ Exp __________
____ Check or Money Order enclosed and payable in US funds
____ Government or educational institution purchase order attached
Order Details
Single user license _______ X $ 295.00 US ...... $ ___________
5 license Pack .... _______ X $1180.00 US ...... $ ___________
10 license Pack ... _______ X $2065.00 US ...... $ ___________
11 or more licenses _______ X $ 195.00 US ...... $ ___________
Florida residents Please add 7% sales tax ....... $ ___________
Total ........................................... $ ___________
Prices are subject to change without notice.