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- SciTech Display Doctor 5.3
- Order/Registration Form (Australian Customers Only)
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- SciTech Software Australia ___/___/___
- 9 Mitchell St MM /DD /YY
- Richmond, 3121 AUSTRALIA
- Phone/Fax: (03) 9428-9810 / (03) 9428 9676
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- PLEASE PRINT OR TYPE CLEARLY!
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- Name: ______________________________________________________________
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- Company: ___________________________________________________________
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- Address: ___________________________________________________________
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- _________________________________________ City ____________
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- State __________ Post Code________ Country ________________
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- Phone: _______________________________ Fax: _______________________
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- Email: _____________________________________________________________
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- Register product(s) to: [ ] Company [ ] Individual
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- Pay By: [ ] Cheque [ ] Money Order [ ] Credit Card
- *$10.00 charge for all returned cheques
- Credit Card Orders: MasterCard / Visa / Bankcard (Circle one)
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- Card Number ___________________________________ Expires ___/___
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- Exact name on card (print) ____________________________________
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- Price List Cost Qty Price
- ------------------ ------------------ ----- --- ------
- Display Doctor 5.3 A$44.95* ___ $ ______
- Disk & Manual A$15 ___ $ ______
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- *Includes any 5.x upgrades (available online)
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- Subtotal: $ ______
- Freight Charges (See below for amount!): $ ______
- Total Enclosed: $ ______
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- I have read and agree to abide by the enclosed license agreement and I
- agree to be bound by my credit card agreement.
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- (Signature required) _____________________________________
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- SHIPPING CHARGES: If a disk & manual are ordered the freight charge is A$6.
- Orders without disk & manual will receive a receipt and registration code
- via postal mail for no additional charge.
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