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