popid_order_form="GetWebPics (product number 4479-10): order form \n\r=========================================================== \n\r\n\rMail this form to: Universal Commerce, Inc. \n\r ATTN: Orders \n\r PO Box 1816 \n\r Issaquah, WA 98029 \n\r United States of America \n\r\n\rOr fax it to: 1 888 353-7276 (U.S. and Canada; toll-free) \n\r 1 425 392-0223 (other countries; regular) \n\r\n\rOr just call: 1 877 353-7297 (U.S. and Canada; toll-free) \n\r 1 425 392-2294 (other countries; regular) \n\r\n\r\n\rCheck, money order, purchase order or credit card order accepted \n\r~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ \n\rNote: for mailed orders, the checks need to be made out to Universal \n\rCommerce Inc. The product ID (4479-10) should be mentioned on the \n\r\"memo\" of the check. Checks and money orders should be drawn in US \n\rFunds. A purchase order must be faxed or mailed to the address listed \n\rabove with all necessary information including billing information. \n\r\n\r\n\rOrder Information \n\r~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ \n\r\n\rGetWebPics (4479-10) Price/Unit Quantity Total \n\r---------------------------------------------------------------------- \n\rPersonal license ____ ____ ______ \n\rMail or fax order \$2.50 ______ \n\r\n\rTOTAL AMOUNT (\$U.S.) __________ \n\r\n\rNote: if you place an order by fax (with credit card), or pay with \n\rcheck, money order or purchase order, please include additional \n\r\$2.50 (see above). Otherwise, your order will not be processed. If you \n\rplace an order by phone, you\'ll be charged for additional \$3. For \n\ronline orders, there are no additional charges. \n\r\n\r\n\rPayment Information \n\r~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ \n\r\n\rFirst Name: _____________________________________________________ \n\r\n\rLast Name: _____________________________________________________ \n\r\n\rCompany: _____________________________________________________ \n\r\n\rStreet Address: _____________________________________________________ \n\r\n\r _____________________________________________________ \n\r\n\rCity:\t\t _____________________________________________________ \n\r \n\rState/Province: _____________________________________________________ \n\r\n\rZip/Postal Code: _____________________________________________________ \n\r\n\rCountry: _____________________________________________________ \n\r\n\rDaytime Phone: _____________________________________________________ \n\r\n\rFax: _____________________________________________________ \n\r\n\rEmail Address: _____________________________________________________ \n\r\n\rPayment: __ MasterCard __ VISA __ AMEX __ Discover \n\r __ Check __ Money order __ Purchase order \n\r\n\r\n\rFor credit card orders: \n\r\n\rName on Card: ________________________________________________________ \n\r\n\rCredit Card Number: __________________________________________________ \n\r\n\rExpiration Date: month _______________ year (4 digits) _______________ \n\r\n\r\n\r Signature : ____________________ Date: ______________ "
