|
Hurstridge Technologies Order Form |
|
Fill in the information below and send, with
payment, to: |
|
Customer Information |
|
|
|
|
|
Name |
|
|
|
|
|
Company |
|
|
|
|
|
Address |
|
|
|
|
|
|
|
|
|
|
|
Phone |
|
|
|
|
|
Shipping |
|
|
Address |
|
|
|
|
|
Radix User Licenses |
|
|
|
|
|
|
I would like to purchase ______________ User Licenses @ $49.95 per License. |
|
Subtotal |
________________ |
|
Tax: (6% in KY) |
________________ |
|
Total |
________________ |