RegSoft.com FAX Order Form

Please fill in the form below Completely, print it out and FAX it to 1-208-279-3837
Or try our new Toll Free fax line at 1-800-886-6030
(UK Customers can fax to (0870)132-2485.)

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 :

35867

Product Name :

PE Explorer

Units From	Up to	Price Per Unit
1	unlimited	$ 69.00

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:
State/province:
Country:
Zip/postal Code:
Phone Number:
Fax Number:
Select type of credit card:
Card Number:
Expiration Date:

Georgia Residents Please include 7% Sales Tax