FAX or Mail Order

Please print and fill out this form and fax to us or mail to this address:
Belltech Systems, Attn: Sales
Fax: (206) 274-4869
https://www.belltechsystems.com

Your Purchase Information:

Your Name__________________________
Your Email__________________________
Company Name(optional)__________________________
Address________________________
________________________
City___________________________
State___________________________
Zip___________________________
Country___________________________
Phone # _________________________________

Order Details

Qty.	Product Name	CD-ROM	Price
____	____________________	Yes/No	__________
____	____________________	Yes/No	__________
____	____________________	Yes/No	__________
____	____________________	Yes/No	__________
____	____________________	Yes/No	__________

Attach your Money Order, payable to Belltech Systems, or provide your payment information below.

Payment Information (if paying by credit card)
Name on Credit Card: ________________________________
Card type (circle one): Visa, Mastercard, American, Express, Discover
Card Number: ___________________________
Card Expiry Date( month/year ) : ______ / _____
Total amount to be charged:______________
Card holder's signature : ________________

Pricing Guidelines for PO

Business Card Designer Pro 5-user license: US $149.95

Business Card Designer Pro 1-user commercial license: US $99.95

Small Business Publisher 5-user user license: US $199.95

Greeting Card Designer 1-user Commercial license: US $199.95

Label Maker With Data Merge 5-user user license: US $199.95

CaptureXT Screen Capture 5-user user license: US $127.50

Software in CD-ROM: Please add an additional US $12.95 + $2(shipping) for each CD

Volume discount may be available from time to time. Please contact us for more info.

Shipping Note: Shipping is by USPS 1st class ground. For USPS priority delivery please add $10 more.

Signature:_________________
Full Name:__________________________
Date:____________________