| Date: |
_________________ |
| Contact Name: |
_________________________________________________________ |
| Educational Institution Name: |
_________________________________________________________ |
| Shipping Address: |
_________________________________________________________ |
|
_________________________________________________________ |
| City, State, Zip: |
_________________________________________________________ |
| Country: |
_________________________________________________________ |
| Phone: |
_________________________________________________________ |
| Fax: |
_________________________________________________________ |
| E-Mail Address: |
_________________________________________________________ |
| |
Billing Address:
(if different) |
_________________________________________________________ |
|
_________________________________________________________ |
| City, State, Zip: |
_________________________________________________________ |
| Country: |
_________________________________________________________ |
| |
| Credit Card: |
[ ] MasterCard [ ] VISA [ ] AMEX [ ] Discover |
| Credit Card #: |
_________________________________________________________ |
| Expiration Date: |
_________________________________________________________ |
| Name On Card: |
_________________________________________________________ |
| Signature: |
_________________________________________________________ |
| |
|
| Using a Purchase Order: |
Submit your signed, official organization’s purchase order to ++1-860-429-3542or attached to your email to sales@winzip.com.
Purchase orders are subject to credit approval. |