SciTech Display Doctor 1.0 for Linux Order Form SciTech Software, Inc. __/___/___ 505 Wall Street MM /DD /YY Chico, CA 95928 USA Toll free: 800-486-4823 Phone: 530-894-8400 Fax: 530-894-9069 sales@scitechsoft.com www.scitechsoft.com PLEASE PRINT CLEARLY OR TYPE! Name: _____________________________________________________________________ Company: __________________________________________________________________ Address: __________________________________________________________________ City: __________________________________ State: __________________________ Zip/Postal Code: _______________________ Country: ________________________ Phone: _________________________________ Fax: ____________________________ Email(required for orders placed via email):_______________________________ Register product(s) to: [ ] Company [ ] Individual Pay By: [ ]Check*(USA only)** [ ]Money Order(US Funds)** [ ]Credit Card *$15.00 charge for all returned checks **Orders cannot be processed until payment is received Credit Card Orders: MasterCard / Visa / Amex / Discover (Circle one) Card Number ______________________________________ Expires ____/____ Cardholder's name (print) ____________________________________________ Item Cost Qty Price ------------------------------------------- -------- --- ------ Linux Installation SciTech Display Doctor 1.0 w/Media & Manual US$39.95 ___ $ ______ Subtotal $ ______ California residents ONLY add sales tax 7.25% $ ______ Shipping & Handling Charges US: $7.95 Intl: $14.95 $ ______ Total Enclosed $ ______ I have read and agree to abide by the enclosed license agreement and I agree to be bound by my credit card agreement. If shipping charges have changed, I agree to pay the new charge. (Signature required) _____________________________________ Shipping charges are subject to change without notice