Order Form for NetScan (SWREG #1197001-NS)

BY FAX

To order by fax using a credit card, please print out this document, complete it and fax to Soft Shop.

Following are our fax numbers - all are toll free unless marked with a *.
If your country is not listed please fax to the USA number +1 (978) 336 0331

Australia 1800 013971

Ireland 1800 509147 Spain 900 95 8968
Belgium 0707 03334* Italy 800 781703 Sweden 0207 94125
Finland 0925 360011* Netherlands 0208 845094* Switzerland 0800 835140
France 0800 917034 New Zealand 0508 555300 UK 08701331269*
Germany 0800 1808295 Portugal 800 844030

USA or Canada 866 219 9380
(978) 336 0331*

BY PHONE

If you prefer you may phone the following numbers and give your complete order - English Language only. When requested for your card number do not tap it in but speak it. The product code is shown as the SWREG# above.

If your country is not listed below please call the UK number +44 1297552862

Australia 1800 069620

Norway 800 10772

Germany 0800 1808206

Portugal 800 844031

Ireland 1800 509145

Spain 900 95 8969

Italy 801 781702

Sweden 0207 96278

Netherlands 0800 0232865

Switzerland 0800 835132

New Zealand 0508 555200

USA 866 500 6750

 

Ship-To Name & Address:

First/Middle Name:

Last Name:

Company Name:

Address:

 

 

 

Phone + Fax:

Your E-Mail Address - In Capitals:

Card Number (MC, Visa, Amex, Discover, Switch, Delta, Eurocard, Diner's):

Expires - Month: Year::

Start Date (Diners only):
Issue Number (Switch only):

Credit Card Holder's Name & Address for Verification: Do NOT enter the BANK's name or address in the fields below. Enter the address where the cardholder receives the statements. (Only fill out the spaces below if the credit card holder's name or address is DIFFERENT from the Ship-To Name and Address entered in the spaces above.)

Name on the Card:

Company Name:

Address:
(if different to above)

 

 

 

Order Details:

Item

Price

Quantity

Subtotal

NetScan with Personal License

$12.95

 

 

Fax Handling Fee

$3

1

$3

 Total Order Amount in US Dollars 

 

Card holder will pay card issuer above amount pursuant to cardholder agreement

 

Signature: __________________________________

We accept most cards including Discover, JCB, Eurocard, Diner's Club, Delta, Switch, Visa, Amex, Mastercard but we charge a 3% surcharge on Diner's Club