! Note: We highly recommend you to use the on-line order form: 
! https://www.regnow.com/softsell/nph-softsell.cgi?item=1639-3 
! Please use below off-line form if you can't order via Internet.            

PicturesToExe (product number 1639-3): order form
=========================================================

Mail this form to:      RegNow/Digital River
                        Dept# 1639-3
                        9625 West 76th Street
                        Eden Prairie, MN  55344
                        United States of America

Or fax it to:           1-800-442-3172  (U.S. and Canada; toll-free)
                        +1 952-646-5604 (other countries; regular)

Or just call:           1-877 353-7297  (U.S. and Canada; toll-free)
                        +1 952 646-5331 (other countries; regular)

Check, money order, purchase order or credit card orders accepted
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Note: for mail orders, the checks need to be made out to "Register
Now!" and sent to the address above. For international checks, the
funds need to be in USD and drawn on a bank with a branch in the US.
A purchase order must be faxed to +1-425-392-0223 (US) or mailed to:

(For Purchase Order Use Only):
Register Now!
PO Box 1816
Issaquah, WA.  98027
United States

with all necessary information including billing information.


Order Information

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

PicturesToExe (1639-3)        Price/Unit     Quantity      Total (USD)
----------------------------------------------------------------------
Personal license                $24.00         ____           ______
Business license                $30.00         ____           ______
Advanced business license       $59.00         ____           ______
Mail or fax order               $2.50
______
Purchase order                  $10.00                        ______

Sub Total
______

Sales Tax on Sub Total
______
(MN residents add 6.5% sales tax.  WA residents add 8.8% sales tax.)

VAT on Sub Total (EU only)                                    ______

Total with any applicable Fees, Sales Tax and VAT             ______ (USD)


Note: If you place an order by fax (with a credit card), or pay with
check or money order, then please include the additional $2.50
fee.  If you are paying by Purchase Order then please include
the $10.00 Purchase Order fee (see above). Otherwise, your
order will not be processed. If you place an order by phone,
you'll be charged for additional $3 fee. For online orders, there
are no additional charges.


Payment Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First Name:      _____________________________________________________

Last Name:       _____________________________________________________

Company:         _____________________________________________________

Street Address:  _____________________________________________________

                 _____________________________________________________

City: 		 _____________________________________________________

State/Province:  _____________________________________________________

Zip/Postal Code: _____________________________________________________

Country:         _____________________________________________________

Daytime Phone:   _____________________________________________________

Fax:             _____________________________________________________

Email Address:   _____________________________________________________

Payment:         __ MasterCard     __ VISA     __ AMEX     __ Discover
                 __ Check       __ Money order       __ Purchase order


For credit card orders:

Name on Card: ________________________________________________________

Credit Card Number: __________________________________________________  

Expiration Date: month _______________ year (4 digits) _______________


                Signature : ____________________  Date: ______________

