Client #:           if assigned
Name:              
E-mail address:     required
Shipping address:  
                   
City, state, zip:  
Telephone
   1st:            
   2nd:            

PLEASE CLICK ON ONE OF THE FOLLOWING CIRCLES:

 DEMO    Free Demo Unit                    FREE    FREE      $ NO CHARGE
 BIG     The big item                 50,000.00 + 17.94 S&H  $ 50,017.94
 LITTLE  The little item                    .50 +   .94 S&H  $      1.44

ELECTRONIC PAYMENT: Please fill in your check or credit card charge slip as if you were going to give it to us, then record it in your transaction register. Copy the check/credit card into the blanks below. The electronic payment will appear in your next statement. That's all there is to it!

PLEASE CLICK ON ONE OF THE FOLLOWING CIRCLES:

Payment Method

 Master Charge
 VISA
 American Express
 Check


Payment by CREDIT CARD:
Name on Front of Credit Card:  
Credit Card number:            
Expiration Date:                 e.g. 12/98



Payment by CHECK:

(All of the following information should be found on the front of your check).

Your check number  
Transit number:     e.g. 12-34/5678 at upper right check corner

Pay to 
  the order of:    CORPORATE DATA PROCESSING

Amount of check:  $  U.S. Funds
Amount in words:     Dollars

Account name:      
Signer on Account:  Spell exactly as signed
Second signer:      If required

Branch Name:       
Bank Name:         
Street address:    
                   
City, state, zip:  
Bank Telephone:    

Routing Number      :9-digit: MICR number BETWEEN 2 colons at check's lower edge.
Account Number      The other 9 or 10-digit MICR number NOT BETWEEN colons.