HexaTech FarFast Form Filler Order Form
HexaTech, 357 Castro Street, Ste. 7, Mountain View, CA 94041, U.S.A.
Tel: (650) 938-0128 Fax: (650) 938-0168
E-mail: sales@hexatech.com
To order, call us or fill out this form and fax or send it. After receiving the order form, we will issue you a license serial number and a password for unlocking the software package downloaded via the Internet. All our products are royalties free. Multi-users must purchase multi-copies.
How did you first hear about the product?__________________
Name:______________________________________________________
Company:___________________________________________________
Address:___________________________________________________
City:__________________________State:_____Zip:_____________
Country:___________________________________________________
Phone:_____________________ Fax:__________________________
Email:_____________________________________________________
QTY PRICE TOTAL
PRODUCT (in units) (per unit) (US $)
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FarFast Form Filler ________ $99 _________
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Total units: __________
S/H Charges (see below): __________
Subtotal: __________
Sales Tax 8.50% (California customers only): __________
Total US FUNDS: __________
[ ] Check or Money Order Enclosed (Payable to HexaTech)
NOTE: Checks must be drawn on American Banks only.
[ ] Charge my...
[ ] Visa [ ] MasterCard [ ] American Express
Card Number__________________________________ Expiration Date___________
Cardholder's Name____________________________