| Order form for Group Net Send v1.01 - by RJL Software Inc. | |
| Full Name: | _____________________________________________ |
| Company Name: | _____________________________________________ |
| Street Address: | _____________________________________________ |
| City, State, postal code: | _____________________________________________ |
| Country: | _____________________________________________ |
| Phone Number: | _____________________________________________ |
| Fax Number: | _____________________________________________ |
| Email Address: | _____________________________________________ Most Important! We use email to communicate with you. |
| Product Ordered: |
Group Net Send - Server License $49.99 USD per license Qty _________ Group Net Send - Site License $249.99 USD per license Qty _________ |
| Payment Details (circle one): |
Credit Card Money Order Purchase Order |
| PO Number (if applicable): |
_____________________________________________ |
| Credit Card Type (if applicable): |
Visa Mastercard American Express Discover |
| Name on Card: | _____________________________________________ |
| Card Number: | _____________________________________________ |
| Expiration Date: | __________________ |
| Date / Signature: | _____________________________________________ |
| If paying by money order, make it payable to: RJL Software, Inc. 340 Warwick Lane LITH, IL 60156 | |
| If ordering by fax, please fax this form to (847) 841-4216 | |