TriBatch Order Form

Please fill out and send this order form together with your payment to:

info@trimill.com

Trimill Industrial Systems
530 West 19th Street
North Vancouver, BC
CANADA V7M 1X9

TriBatch Pro License(s)

( ) 1st license                                 CAD 1,900.00

+ Additional licenses to the same name:

  Additional license 2-5,   ____ x CAD 1,400.00 = _________

  Additional license 6-10,  ____ x CAD   900.00 = _________

  Additional license 11 +,  ____ x CAD   600.00 = _________

TriBatch Lite License(s)

( ) Number of licenses      ____ x CAD   290.00 = _________

                                        Total CAD _________

Registered User Name (your name OR company name - please check off):

( ) Name       _______________________________________________

( ) Company    _______________________________________________

Address        _______________________________________________

City           _______________________________________________

Province/Country______________________________________________

Zip/Postal code_______________________________________________

Phone/FAX      _______________________ / _____________________

E-mail address _______________________________________________

Payment:

( )Check ( )Money Order ( )Cash ( )Purchase Order #: _________