TOTAL Software, Inc.
9511 Hwy 5 N, #14
Alexander, Arkansas 72002-7917
(800) 951-6430


FAX ORDER FORM

FAX: (501) 847-8752

Please check the following that you wish to receive.
____  Please send MORE INFORMATION about the D/PAC Software.
____  Please send the D/PAC Software Package, I am ordering:
      ____  $1,995.00 - Single User Module
      ____  $1,200.00 - Additional Users:  ____ Users x $1,200.00 
      ____  $  995.00 - Additional Companies:  ____ Companies x $995.00
 

Check METHOD OF PAYMENT:
____  I am sending a check for the total amount purchased.  (Amount: $___________)
____  Please charge my credit card listed below.  (Amount: $_____________)
      Check one:  ____Visa    ____MasterCard    ____American Express  ___Discover
      Account Number:  ______________________________________  Expires:  ____/____
 
Contact: __________________________________________________________________________
Company Name:  ____________________________________________________________________
Address:  _________________________________________________________________________
City:  _____________________________________ State:  _____  Zip Code:  ____________
Telephone:  _____________________________  Fax:  __________________________________
Authorized Signature:  ____________________________________________________________
 


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