FAX Order Form for fKey Keyboard Template Designer (Product ID: # 17116)
To order by FAX using a credit card, please print out this topic, complete it and FAX to RegSoft.com at (770) 497-9234.
(Country code "1" for orders outside North Amercia.)
  Section I - SHIP TO: (Name & Address)

First/Middle Name:

Last Name:

Company:

Address Line 1:

Address Line 2:

City:

State/Province (US & Canada only):

Zip/Postal Code, Country:

Phone:

FAX:

Your email address:

Credit Card Number (MC, VISA, AMEX, Discover):

Expiration (Month/Year):

Code from back of card: (xxx)

Enter the BANK's name and phone number from the back of the card or from your statement. For AMEX, just enter 'AMEx' in the box. All others MUST have the bank's name and phone number.


  Section II - Credit Card Holder's Name & Address:
Do NOT enter the bank name and address in the boxes below. Enter the address where the cardholder receives their statements.
(Fill in this section ONLY if the credit cardholder's name and address is DIFFERENT from the "SHIP TO" name and address entered above.

Name on the card:

Company:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip, Country:


  Section III - Order Details:
Item
 Price
 Number
 Extension
Registration of fKey Keyboard Template Designer (# 17116)
(Includes CD-ROM with latest version of the program.)
 $ 40.00
    
Electronic registration of fKey Keyboard Template Designer (# 17116)
(Registration ID only, for internaltional customers.)
 $ 40.00
    
Network License, up to six simultaneous users on network.
 $ 170.00
    
Additional users on network (per additional user)
 $ 12.00
    
Shipping & Handling outside US & Canada
(not applicable to email delivery)
 $ 10.00
    

 Total Order Amount in US Dollars 

  

Card holder will pay card issuer the above
amount pursuant to the cardholder agreement.                                              Signature:_______________________________________

This site maintained with FlexSite32                                                              Last modified: 2003-06-29 15:37:30   Filename: fkeyfax.html