ORDER FORM - SINGLE ORDER WinCLI V3.00 *********************************************************** For multiple copies or site licenses please call Eschalon Development Inc. at (604) 520-1543. *********************************************************** NAME/CONTACT_______________________________________________ COMPANY____________________________________________________ STREET_____________________________________________________ CITY_______________________________________________________ STATE_________________________ ZIP_____________________ TELEPHONE _______________ FAX _________________________ WinCLI license number.......................$40.00...______ B.C. residents add 6% sales tax............($ 2.40)..______ Canada residents add 7% GST................($ 2.80)..______ Shipping and handling.......................$ 0.00...______ ========== Total in Canadian funds on Canadian Bank.............______ VISA #_____________________________________ Exp. Date______ Name On Card_______________________________________________ Make checks or money-orders payable to: Eschalon Development Inc. Mail to: Eschalon Development Inc. 110-2 Renaissance Sq. New Westminster, BC V3M 6K3 Canada *VISA will be charged in Canadian dollars.