FROM MY KITCHEN PURCHASE REQUEST

Using your Windows Notepad or similar text editor, complete the following information, then follow the instructions at the bottom.

NAME:
STREET ADDRESS:
STREET ADDRESS:
CITY:
STATE:
ZIP OR POSTAL CODE:
COUNTRY (if not US):

TELEPHONE NUMBER:

EMAIL ADDRESS:                    

I want to purchase:
Serial number key.................................................$ 17.00
If you are a resident of Virginia, please add 77 cents............$   
TOTAL.............................................................$

I WANT TO PAY BY:
(  ) CREDIT CARD

Full name exactly as it appears on credit card statement:
Type of card:
Credit card number:
Expiration date: 

(  ) CHECK

Make check for the amount above, payable to "ComputerEase"


Mail this completed form to:

ComputerEase
Dept CEBS-04
7204 John Elizabeth Place
Prince George, VA 23875


Your serial number will be emailed to the email address you entered above - please double-check it for accuracy and legibility!