tcasoftware.net Mail Order Form for PANELS© 4.5

Please completely fill in the form below,
then print out this form from your browser to your local printer
and mail it with a Check or Money Order, Payable to:

TCA Software Inc.
429 Canvasback Road, Suite 103
Mooresville, NC - 28117


*If you are paying via credit card, just fill out the credit card information below. Orders paid by personal or business checks will be shipped within 5 business days.


Product Name:   PANELS© 4.5
Price:  
$
249.00
If ordering more than 1 copy,
refer to pricing chart on the
Prices & Orders page.

Quantity:  

 Support Option:  


Refer to pricing chart on the Prices & Orders page for options.
Yes No


(As it should appear on the program start-up screen)

Registration Name
(required)


Please be sure your email address is correct!
This is how you will receive your confirmation.

Billing Address

Email Address:
Full Name:
Company Name:
Billing Address:
Billing Address (cont'):
City:
State/province:
Country:
Zip/postal Code:
Phone Number:
Fax Number:
Select type of credit card:
* V CODE
Card Number: (no spaces and no -'s)
Expiration Date:
* V CODE is the 3 numbers on back of card (right)



Shipping Address

Email Address:
Full Name:
Company Name:
Billing Address:
Billing Address (cont'):
City:
State/province:
Country:
Zip/postal Code:
Phone Number:
Fax Number:


North Carolina Residents Please include 6.5% Sales Tax