Please fill in the form below,
print it
out, and FAX toll free to 1-866-425-2670
or Mail it with a Check or Money Order in US Dollars,
made out to CyberMatrix Corp. Inc. at:
3104-30th Ave
Suite #224
Vernon, B.C. V1T 9M9
Program Name
Number of
licenses i.e. 10 Seat
etc. enter Site for a site license
Price
Shipping
5% GST
[Canadian customers only]
7% PST
[Bristish Columbia customers only]
Billing Information:
Email Address:
Must be filled
in
for products shipped by Internet
Name:
Exactly as it appears on credit card
Company
Name:
(optional)
Address:
Exactly as it appears on your
statement
(make sure to include your country)
Shipping
Address:
(If different
from billing address.)
Phone
Number:
Credit
Card:
Credit
Card #:
Exp Date
Card
Identification #:
(Number
printed in black ink above the embossed card number - Amex only)
Purchase
Order# (P.O.): (Only
if using a purchase order.) (Include your standard
credit references form.)
Notes:
(Include any other details about the
order.)
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our
software?
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