KipwareTBŽ Order Form

Shipping via C.O.D. -- Pre-Pay -- or use your Credit Card

Please print (from your BROWSER, click FILE on the Toolbar, click PRINT, then follow the on-screen instructions) and complete this form, then fax it to: (508)752-9733 for COD or CREDIT CARD billing or mail it along with your check to: Kentech Inc., 265 Mower Street, Worcester, MA 01602.

Name: _________________________________________________

Company: ______________________________________________________________

Ship Address : ________________________________________________________

Mail Address : ________________________________________________________

City/State/Zip: _______________________________________________________

Telephone #: ____________________ ......Fax # : ________________________

E-Mail Address: _______________________________________________________

Prices:
[____] KipwareTBŽ Software - Full Version --- $ 125

Shipping / Handling Options ::
[____] Web Download - No Physical Media - Deduct $10
[____] Web Download with Back-Up CD and Manuals ( $15.00 )
[____] Next Day Delivery ( $45.00 )
[____] 2nd Day Delivery ( $30.00 )
[____] 3 Day Delivery ( $20.00 )
[____] Standard Ground Delivery ( $10.00 )
[____] International Delivery - Web Download Only Available - Deduct $10

MA Residents must add 5% Sales Tax

[......] Enclosing a check for $_______
[......] Ship By C.O.D. ( Add an additional $7.50 to cover COD Fees - Only available within the U.S. )
[......] Bill to my -- Visa -- MasterCard -- American Express -- Discover ( please circle desired card )

Credit Card Information : ( for security reasons - fax this form or call in your order )
Name on the Card : _____________________________________________
Complete Billing Address : ______________________________________________
Credit Card Number : _____________________________________________
Expiration Date : _____________________________________________
Signature _____________________________________________