Print this form, complete, and fax or mail.

Filtrix for Windows Order Form (Overseas)

Order date: ______________________

Name of end user (person, not company): ___________________________________________

Company/Organization: _____________________________________________________________



User address: _____________________________________________________________________

City/Code:________________________________________

State/Province: __________________________________ Country: _______________________


Telephone:_______________________________ Fax: ____________________________________

Email:___________________________________





Platform:  ______ Win 95/98/NT/XP  For added or multiple 

licenses, give number of licenses to run concurrently on a network: __________


                    ______ licenses @ $218 per license: ____________

		     Upgrade: $56.00 per lic. per year: ____________

   
						 Total: ____________


NOTE: NO RETURNS OR EXCHANGES. Enclosed is payment in the form of:


____Check (US funds only)

____Visa    ____MasterCard    ____AmEx (incl. card ID#)

Card #: _________________________________  Exp. Date: ______________

Cardholder signature: ______________________________________________

Add full cardholder name/addr. if not as above: ____________________

____________________________________________________________________
If you indicated "FTP" you will receive emailed download instructions.
Overseas prices, dated 9/24/05.
Fax or mail to: Blueberry Software, PO Box 271235, Concord, CA 94527 USA
Fax: 925/887-6687