Guthrie CAD/GIS Order Form

SHXConvert 4.0 Software Order Form

Fax to:
    'International dialing prefix' + 61 3 9923 6200
     If faxing from USA, the International dialing prefix is '011'.
     (In Australia, fax to: 03 9923 6200 )
or
Post to:
     Guthrie CAD/GIS Software Pty Ltd
     PO Box 261 Gumeracha SA 5233 Australia

Name:      ________________________________________

Company:   ________________________________________

Address:   ________________________________________

           ________________________________________

City:      ___________________State:_______________

Post Code: ______________Country:__________________

Phone:     __________________Fax:__________________

Email:     ________________________________________

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Quantity  Item                          Unit Price     Total Price
___________________________________________________________________


          SHXConvert 4.0                USD 150.00

                  (99.00 EURO, 79.00 UK, 219.00 AUD)


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Postage & Handling                                      nil

(This software delivered by download only.)
______________________________________________________  ___________

                                               TOTAL:
___________________________________________________________________

Pay by  ( )American Express ( )JCB ( )Master Card ( )VISA ( )Cheque

Credit Card No. _____________________________ Exp. Date_________

Name on card ___________________  Signature_____________________

Card ID* ____________ (required)

* Card ID for Visa / MasterCard is the 3 digit security code printed on the signature strip after the card number. * Card ID for American Express is the 4 digit number found on the front of your card above the card membership number.

Note 1: If not paying by credit card a Cheque or Money Order must be included with the order.
             Cheque must be in US Dollars or EURO or UK Pounds.
             (Australian customers may send a cheque in Australian dollars)
Note 2: Purchase Orders accepted from government organisations and large companies only.
            Please fax a copy of the Purchase Order.

Thank you for your order.