RegSoft.com FAX Order Form
Please fill in the form below Completely, print it out and FAX it to 1-770-497-9234
If you choose to fill it out by hand PLEASE PRINT LEGIBLY
If we cannot read the form we cannot process the order.
Product ID : 32980
Product Name : EasyMem
Units From Up to Price Per Unit
1
19
$ 19.95
20
99
$ 15.00
100
Unlimited
$ 10.00
Quantity :
Please be sure your email address is correct! This is how you will receive your confirmation.
Compuserve users please use a period (.) instead of a comma(,) 1234.567 not 1234,567
Email Address:
Full Name:
Company Name:
Billing Address:
Billing Address (cont'):
City:
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Country:
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Phone Number:
Fax Number:
Select type of credit card:
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to the RegSoft.com Shareware Site.
Georgia Residents Please include 7% Sales Tax

Oct-12-2000 01:12 PM