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  1. Please print this form and follow the instructions below:
  2. ---------------------------------------------------------------------------
  3.                           DDH Software Order Form
  4.                         Email, Mail, Fax, or Phone to:
  5.  
  6.                                [DDH Software]
  7.                             ATTN: David Haupert
  8.                                PO Box 970971
  9.                           Boca Raton, Fl 33497-0971
  10.                                (561) 470-2133
  11.                          email: sales@ddhsoftware.com
  12.                         web: http://www.ddhsoftware.com
  13. ---------------------------------------------------------------------------
  14.  
  15. First Name:____________________      Last Name:____________________________
  16.  
  17. Street
  18. Address:_____________________________________________________________
  19.  
  20. City:________________________________________________________________
  21.  
  22. State:____________________ Zip Code:___________ Country:_____________
  23.  
  24. Day Phone: _______________________  Eve Phone:_______________________
  25.  
  26. Email address:_____________________________________________
  27.  
  28. Type of Computer you own:
  29. [ ] IBM-PC compatible  [ ] Apple Macintosh  [ ] Other:________________
  30.  
  31. Pilot owned:
  32. [ ] Pilot 1000     [ ] Pilot 5000     [ ] PalmPilot Personal
  33. [ ] PalmPilot Professional   [ ] None
  34.  
  35. Memory installed:
  36. [ ] 128K     [ ] 512K    [ ] 1 MB   [ ] 2 MB   [ ] 3MB   [ ] Other:________
  37.  
  38. Choose Payment Option:
  39. [ ] *Check or *Money Order (enclosed)  [ ] First Virtual  [ ] Credit Card
  40. * Please make payable to: David Haupert
  41.  
  42. Choose shipping option:  [ ] Via Email      [ ] Via Mail (*US Only)
  43.  
  44. If Registering by First Virtual:
  45. First Virtual Pin #:__________________________________
  46.  
  47. If Registering by Credit Card:
  48. Check one:  [ ] Visa    [ ] MasterCard
  49.  
  50. Account Holder full name (as it appears on card) :
  51. __________________________________________
  52.  
  53. Credit Card Account #:
  54. _______________________________________________________________
  55.  
  56. Expiration Date (MM/YY): ___/___
  57.  
  58. Product(s) Available:
  59. Enter the Quantity of each item you would like to register:
  60. ----------------------------------------------------------------------------
  61. Quantity Description                     # Words      Price (US $)   Total
  62. ____     Translate + Danish Language     3787         $12.00         $
  63. ____     Translate + Dutch Language      8633         $12.00         $
  64. ____     Translate + Esperanto Language  8665         $12.00         $
  65. ____     Translate + Finnish Language    3228         $12.00         $
  66. ____     Translate + French Language     7135         $12.00         $
  67. ____     Translate + German Language     9335         $12.00         $
  68. ____     Translate + Hungarian Language  1200         $12.00         $
  69. ____     Translate + Icelandic Language  1106         $12.00         $
  70. ____     Translate + Indonesian Language 1155         $12.00         $
  71. ____     Translate + Italian Language    2275/3526    $12.00         $
  72. ____     Translate + Japanese Language   1806/9752*   $12.00         $
  73.          *Shipped with free larger EDICT_S database
  74. ____     Translate + Latin Language      745          $12.00         $
  75. ____     Translate + Mandarin Language   1491         $12.00         $
  76. ____     Translate + Norwegian Language  1936         $12.00         $
  77. ____     Translate + Portuguese Language 2353         $12.00         $
  78. ____     Translate + Spanish Language    3666/8083    $12.00         $
  79. ____     Hangman + Wheel of Treasure     N/A          $12.00         $
  80. ____     Thesaurus                       52,255       $15.00         $
  81. ------------------------------------------------------------------------------
  82.                                                 Subtotal             $
  83.                                                 Less any Discount  - $
  84. ------------------------------------------------------------------------------
  85.                                                 Total amount         $
  86.  
  87. I authorize David Haupert to charge the appropriate amount as noted above
  88. for providing the appropriate software as listed above.  Software will be
  89. shipped or emailed as noted above.  I understand that the software is
  90. released as shareware and it is protected by copyright from illegal use
  91. and/or copying.  I also understand that the software is released as is, and
  92. that author is not responsible for any damages that may occur from the use
  93. or misuse of this software.
  94.  
  95. Signature:_________________________________________ Date:______________
  96.  
  97.