Name ____________________________________________
Company (if needed) ____________________________________
Address _______________________________________________________
City ___________________________ State/Province ______
Postal Code/Zip ____________
Country ___________________ Phone/Fax ____________________
E-Mail Address ________________________________
Number of licenses _______________________
Total Enclosed ____________________________
Credit Card Information
Type (Visa, Mastercard, American Express, Discover)
Account Name ______________________
Account Number ______________________
Expiration Date _______________________
I authorize Software2Go Inc. to bill my credit card and
agree to pay the total amount according to card issuer agreement.
_________________________ _____________
Signature Date