AccessDiver Fax/Mail Order Form

I am writing to order _____ copies of AccessDiver from GigaMind
Software at $ 36 per copy.  The product ID is  15995

Shipping and Handling of $3 in North America or $5 overseas will
be added if I do NOT opt for email delivery below.

Name:

Address1:

Address2:

City:

State/Province:

Zip:

Country:

Phone # (voice):

Email address:

Email Delivery or Postal Mail:

Credit Card Number:

Credit Card Type (Amex, Visa, MC, Discover):

Expiration (Month/Year):