Computer Sentinel ordering information questioneer

 
    You can order your Computer Sentinel by completing the following questions.
    The Single port version is priced at $259.00. If you want the second port
    option, that is an additional $30.00. Shipping and handling is $25.00.
 
    Description        Total cost in New Jersey   Total cost outside New Jersey
    
    One Port Model            301.04                       284.00
    Two Port Model            332.84                       314.00
 
 
What is your First and Last name?____________________________________________

What is your street address (line1)?_________________________________________

What is your street address (line2)?_________________________________________

What is your city?___________________________________________________________

What is your state?________________ What is your Zip code?___________________

What is your day voice phone number?_________________________________________

What type of device will you use the Computer Sentinel with?_________________

_____________________________________________________________________________

One / Two Port Model?_____________________________

Be sure to include payment in full, the above prices include shipping & tax.