PROM LeaseMaker® Order Form

Your Name

_______________________________________________
Address

_______________________________________________
City St Zip

_______________________________________________
Telephone

_______________________________________________
Email

_______________________________________________

Print this form
complete it, and 

Fax it to us at
, or

Mail it to us at


Please ship the following items:

Description
# Required
Cost each
Total cost
627B LeaseMaker Calculator   299.00  
627B LeaseMaker Calculator Software Upgrade   129.00  
CE-123P Printer (Reconditioned)   99.00  
EA-23E Adapter for Printer   29.00  
Shipping and Insurance   12.00  
Total Amount Due  

[  ]  I have enclosed a check.

[  ]  Please charge the total amount due to my credit card.

Card Type:  [  ] American Express    [  ] MasterCard     [  ] Visa

Card Number ______ ______ ______ ______  Expires ___ / ___ 

Name on card __________________________________________

Billing address _________________________________________

______________________________________________________

Signature _____________________________________________

 


If you have any questions, email us at the address below or call +1 800 843 7766 (9AM to 5PM, Eastern time, weekdays).

12 Mar 2013