Access Whiz Offline Order Form  SIMPLE STEPS TO PLACE AN ORDER: 1. Select the options you wish to order. 2. Fill in the serial # for your designated system. 3. Complete customer information.  4. We accept checks, money orders, Visa, Mastercard, American Express, JCB and Purchase Order by mail. Print & mail a copy along with your check or PO.  *Serial Number (any one of the products you selected)   Subtotal **Discount 20% 40% Fields below for credit card orders only Total Customer Name Company Card Holder Address City State/Province Zip Code Country Phone Card Holder Name Email if different from name above Card Number Expiration Date (mmyy) Card Verification Code ORDER FORM Microtools P.O. Box 2502, Santa Clara, CA 95055, USAsupport@microtools.us *Product Option (Check the options you'd like to order)A - Access to VB .NET(Web Application)B - Access to VB .NET(Windows Application)C - Access to VB6(Windows Application)D - Access to C#(Web Application) E - Access to Crystal Reports *Customer InformationF - Access Form Controls to VB .NET G - Access Form Controls to C# * Required fields.   ** Upgrade/20% Educational/40% Student discounts: Discount requirement: (Invoice#/School Name/Valid Student ID#/Promotion Code) For educational or student discount a school Email address is required. PProduct includes 12-month updates and 90-day email support from the purchase date. All orders are subject to the Converter License Agreement. When you place an order with us online, all of the information is encrypted. Once the order has been processed successfully, you will receive an authorization email with your key code file location within one business day. If you do not receive any email within 12 hours - there may be a problem with your order. Please contact us at support@microtools.us. Purchase orders (net 30 days) are accepted from government agencies and accredited educational institutions and major corporations, provided that they are submitted on purchase order form with a purchase order number. All checks must be drawn on a U.S. bank and in U.S. currency. For offline (mail-in/email-in) charge card order only: Signature:_________________________________ Date:_____________ Prices subject to change without notice: first option price/bundle price US$45/$25 US$45/$25 US$169/$60 US$169/$60 US$94/$40 US$169/$60 US$169/$60