"CHECKER" POSTAL MAIL ORDER FORM

Please copy and paste this order form into any word processor, or just print out this page, and fill out all information.

[ X ] YES!  I want to be able to accept Check-By-Email, Phone, and Fax! Please rush me by email the Secret Download URL for the Checker Software Program. Here is my payment for $14.95 (U.S. Funds Only).

PAYMENT METHOD:

[   ] Visa     [   ] Mastercard     [   ] American Express     [   ] Discover
(Fill in credit card info. below if you checked one of the above options)

[   ] Business/Personal Check     [   ] Money Order
(U.S. Funds Only.)(Please make check or money order payable to: Creative Operations Research)

PERSONAL INFORMATION:

Full Name:___________________________________________

Company Name:______________________________________

E-mail Address (Must have to email you the Download URL!):___________________________________

Address:_______________________________________

City, State/Providence, Zip/Postal Code:__________________________________________

Country:__________________

Phone Number:_________________________

CREDIT CARD INFOMATION:

Type of card:________________________(i.e. Visa MasterCard etc.) Credit Card Number: ________________________

Credit Card Expiration Date (mm/yy): _____________

Your name as it appears on the card: ________________________________

Your billing address for the card (no P.O. Boxes): _____________________________________

PLEASE NOTE: This Charge Will Appear as 'Ibill on Your Credit Card Statement!

Please mail this order form with your payment for $14.95 (U.S. Funds ONLY) to:

Creative Operations Research
11918 SE Division
Portland, OR 97266
U.S.A.