Purchase Form

If you would like to order the software, please complete all fields in the form below.

Please provide the following contact information:

Name

E-mail Address

Phone

FAX

Organization

Title

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

E-mail address

Web-site address (URL)

Please provide the following computer information:

Brand of Computer

Processor / CPUSpeed

Operating System

DOS/Win Version

Please provide the following ordering information:

QTY DESCRIPTION

*plus travel and lodging expenses

If you are a Florida resident you must add Florida Sales Tax. Currently 7.65%

Total Amount Due

BILLING

Credit Card

Cardholder Name (Exactly as it appears on the card)

Card Number

Expiration Date Month Year

SHIPPING

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Tampa Florida ph: 800-755-9482 Fx: 813-909-7534

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Send mail to webmaster@Tehinc.com about this web site.

Designed and last modified: February 12, 2001 by

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*Name*
*E-mail Address*
Phone
*FAX*
Organization
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail address
Web-site address (URL)

Brand of Computer
Processor / CPUSpeed
Operating System
DOS/Win Version

BILLING
Credit Card
Cardholder Name	(Exactly as it appears on the card)
Card Number
Expiration Date	Month Year

SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country