A. Order Form
Product Name Quantity Price
  Total     

B. Billing Information
Full Name:
Company:
Day Phone:
Home Phone:
Fax:
Email:
Address 1:
Address 2:
City:
State/County:
Postal/Zip Code
Country:
C. Shipping Information
Please leave blank if same as billing address
Ship to name:
Ship to address1:
Ship to address2:
Home Phone:
City:
State/County:
Postal/Zip Code:
Country:


D. Credit Card Information
Name on card:
Card Type:
Card Number:
Expire Date:


E. Shipping & Handling charges
Add $14.95 S&H charge for each Scanner or software product you order.

If your total S&H charge is higher then $30, it will be calculated again according to the weight of the package and you will be notified by Email what is the reduced rate.
F. Order Summary Information
Total from part A:
Shipping & handling:
Grand total:
 Fax number: 1 (419) 735-2419