AlachiSoft Order Form

12005 Ford Road, Suite 520, Dallas, Texas 75234; USA
Intl: +1 (214) 764-6933, Fax: 1-(925) 886-2417
Email: sales@alachisoft.com; Web: www.alachisoft.com

Unit to Purchase	Unit Price
(US Dollars)	Quantity	Total	

				

				

Promotion Code (if any):	______________________________			Total (US Dollars):		___________

Credit Card Type: 	_____________  Credit Card Number: _____________________________	Expire Date: ___________

Name on card:	___________________________			Your Email: ___________________________________

Billing Address: 	_______________________________________	Phone (with area-code): _________________________

	_______________________________________

	_______________________________________

I authorize you to charge the above-mentioned amount to the above-mentioned credit card.

Signature:		___________________________

Date:			___________________________