Visual Forms -- Order Form

Visual Forms MD/DC PPT Order Form

Please enter your shipping information:
Company:
Contact Person:
Street Address:
City:
State:	Zip:
Phone:
Fax:
E-Mail:

Please select a platform:

Please select the state and tax year:

Please select one of the following versions: **
Single User - New ($175 + 10.50 tax) $185.50	Network - New ($325 + 19.50 tax) $344.50
Single User-Renew ($150 + 9.00 tax) $159.00	Network-Renew ($250 +15.00 tax) $265.00

Please select one of the following payment options:
Check	Credit Card
If paying by Credit Card please select type:
Credit Card Number
Credit Card Expiration Date		Month Year
Credit Card CVV Code		CVV Code (on back of card)
Billing Address
Billing City, State, Zipcode

** Please note the new tax rate of 6%. All orders will not be processed until 2008.

Complete, print and fax to 866-726-5718 or mail along with your check or credit card information to:

Visual Forms, Inc.
P.O. Box 1126
Germantown, MD 20875-1126

Maryland is usually shipped between the second and forth week of January. The District of Columbia will ship around the middle of June.