-----------  Mile Manager Deluxe 2.1 ORDER TEMPLATE -------------
       (Use this for fax, email, and surface mail orders.)
    (Please see companion file describing "Registration Info")
-----------------------------------------------------------------
Name:
Street Address:
City:
State:        ZIP:
Country:
Telephone (with area code):
Email Address:


___  Register me for an electronic copy at $ 29.95 
     (Note: electronic copy regisration does not include 
      physical setup disks, and is intended for users who
      have downloaded or obtained the application on CD-ROM,
      a shareware web site, or elsewhere.)

___  Register me for a copy including setup disks, and 
     ship the disks to my continental US destination:
     ($ 39.95 plus $ 3.00 s&h)= total $42.95  each.

___  Register me for a copy including setup disks, and
     ship the disks to my location outside continental US:
     ($ 39.95 plus $ 5.00 s&h)= $44.95  each.

Note: purchases to an Arizona address, add 7.15 % sales tax.

1)  ________  Total $ amt of purchase(s), as checked above

2)  ________  Applicable Sales Tax (Arizona destinations)
              (Arizona purchases: line 1 amount X .0715)

3)  ________  TOTAL BILLABLE CHARGES  (Lines 1 plus 2)

4) THIS IS PsL PRODUCT NUMBER #15342, Mile Manager Deluxe.  

MY CREDIT CARD INFORMATION
Card Type (Visa, MC, Discover, etc) :
       Card Number :
 Expiration (MM/YY):


------------------------ End of Order Template -------------------