JustData
Bodhi History Order Form (Stand-alone: 1 Category)
Please complete the blue areas on this Order Form and Mail or Fax it to the Address indicated at the end of this form. To ensure a swift processing of your order, please type details in all relevant sections. ( * = Required Fields)
Address Details
*Number/Street :
*Suburb/City :
*State :
*PostCode/Zip :
*Country :
Contact No.
*Day Phone :
Facsimile :
*Email Address :
Where did you hear about this software?
What charting software do you use?
* When entering Phone/Fax numbers please enter the complete International codes and prefixes.
Product
Unit Price
Bodhi History - One Category (on CD-ROM)
$ 150.00 AUD
Postage and Handling
$ 11.00 AUD*
TOTAL AMOUNT
$ 161.00 AUD
Historical Categories - Select 1 history category from the drop-down box below: ---------------------------------------------------
Additional Categories - Select additional categories at $150/each from the drop-down boxes below: -----------------------------
Additional categories can be selected for $150 extra per/category (select above) =================>
$
GRAND TOTAL (Total $161 plus added History) =========================================>
$
All historical data purchases are non-refundable.
* Australian Postage. International Postage will be charged at cost.
Paying By Credit CardIf you intend to pay with a Credit Card please complete the section below.
Select Card Type :
Card Number :
AMEX Security Code :
Name on Credit Card :
Expiry Date :
Signature on Card :
Total Amount :
$
AUD
Paying By Cheque/Money Order
Please find attached a Cheque for the Grand Total Amount listed in the Product section of this form.
Mailing Details
Please Mail this completed form, with the Attached Cheque/Bank Draft (if applicable) to the following Address: or Fax: (07) 3821 1287 (Australia) | Fax: + 61 7 3821 1287 (International)
JustData - PO Box 1067
Cleveland QLD 4163 AUSTRALIA