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Fax Order Form for The Financial File Converter
(SWREG # 1293TFFC)
To order by fax using a credit card, please print
out this document, complete it and fax to Soft Shop. Phone
numbers are here.
Ship-To Name & Address:
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First/Middle Name:
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Last Name:
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Company name: |
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Address:
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Phone + Fax |
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Your email address - in capitals: |
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Card number (MC, Visa, Amex, Discover, Switch,
Delta, Eurocard, Diner's):
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Expires- Month: Year::
Start Date (Diners only):
Issue Number (Switch only):
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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.)
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Name on the card:
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Company name:
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Address:
(if different to
above)
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Order Details
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Item |
Price |
Quantity |
Subtotal |
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The Financial File Converter (1293TFFC) |
$US20 |
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Fax handling fee: |
$3 |
1 |
$3 |
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Total Order Amount in US
Dollars |
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Card holder will pay card issuer above amount
pursuant to cardholder agreement |
Signature: __________________________________
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