HSD Fax/Mail Order Form

Herrin Software Development, Inc.
41 South Highland Ave.
Prestonsburg, Kentucky 41653
Fax/Orders: (606) 889-9725

All information is required except the fax number. Print this fax form on your printer, fill in all fields, then fax or mail your order to us. You will receive e-mail confirmation of your order within 24 hours of receipt.

Billing Information


Name ___________________________________________________________________

Street ___________________________________________________________________

___________________________________________________________________

City ________________________ State/Province ___________________________

Post Code _____________________ Country ________________________________

Phone number _____________________

E-mail address _____________________

Requested password _____________________

Credit Card (Visa, Mastercard, or American Express) ______________________

Card # ________________________________________ Expires __________________

Signature _____________________________________


Check or money order payment accepted, payable in US funds only please!

Order


Qty Description Price Total _________________________________________________________________________

Qddb commercial binary subscription (ftp,1 year) $49.95 _________________________________________________________________________

Gustar+Qddb subscription (ftp,1 year) $199.95 _________________________________________________________________________

Qbib bibliography source subscription (ftp,1 year) $29.95 _________________________________________________________________________

Qddb single-user support + binaries (1 year) $479.95 _________________________________________________________________________

Qddb programmer support + binaries (1 year) $1995.95 _________________________________________________________________________

ORDER TOTAL: