Name: | ___________________________________________________________________ |
Company: | ___________________________________________________________________ |
Telephone: | _______________________ Fax: _______________________ |
Email Address: | _________________________________________________________ |
Mailing Address: | _________________________________________________________ |
_________________________________________________________ |
City: | _______________________ State/Province: _________________ |
Country: | _____________________ ZIP/Postal Code: _______________ |
Product Ordering and Total Amount:
Credit Card Information (print clearly):
Number of MrSID Tools for ER Mapper Pro Licenses:
________________ (US$195 each)
Number of MrSID Tools for ER Mapper Image Compressor Unlimited Licenses:
________________ (US$195 each)
Total price (US$):
________________
Card Type:
VISA _______ MasterCard _______ American Express _______
Credit Card Number:
___________________________________________
Expiration Date:
_______________
Name on card:
_________________________________________
Signature:
_________________________________________
Shipping:
Product(s) delivered via web download link in password-protected ZIP format.