________________________ BLUEVIEW SOFTWARE | MagniPaint v3.3 | 2300 Lawrence Ave. East BOX 80551 | | Scarborough, Ontario |------ VISA ORDER ------| CANADA M1P 2R0 |________________________| NOTE: ALL information requested below must be that of the card holder. VISA orders will processed by "Proven Solutions Inc." Please make a note of this. Name (EXACTLY as it appears on the VISA card): ____________________________________________________________________________ Address: Apartment/Suite: _________________________________________ __________ City/Town: State/Province: ________________________ ___________________________ Zip/Postal Code: Country: ________________________ ___________________________ Phone Number : ( ) Date: ________________________ ___________________________ VISA Number : Expiry Date: ______________________ ____________________________ Bank drawn on : _____________________________________________________________ Signature : _________________________________________________________________ --------------------------------------- | Quantity | Price | Total | --------------------------------------- x $24.00 Cdn = ___________ ____________ Ontario residents add 8% pst ____________ Canadian residents add 7% gst ____________ TOTAL ____________ * PRICE indicated in Canadian funds.