KARMA TRITON Order Form - FAX or Mail

Print this form, fill in the information, and fax to (908) 654-1180 or mail to:
Karma Lab
P.O. Box 191
Westfield NJ, USA 07091-0191

Customer Information

First Name:______________________Last Name:________________________

Telephone:_______________Fax:_______________E-Mail:_________________

Home/Billing Address (to which your credit card bills are sent):

Street Address:____________________________________________________

City:_____________________________________________________________

State, Province:____________________________________________________

Country:___________________________Post Code (Zip):__________________

Payment Method

[
...] VISA .........[...] MasterCard .........[...] American Express

Person's Name on Credit Card:________________________________________

Credit Card Number:_________________________________Exp Date:________

Signature:_________________________________________________________

[   ] Check (U.S. Checks only)
.............................[   ] Money Order (U.S. Funds only)

Please make payment to: Karma Lab.
(Payment must be included with order. Do not send cash.)

Charges

[   ] KARMA TRITON Download Version..............................................$199.00 ________
(You will be sent a URL for downloading the software,
along with complete instructions.)

.................--- OR ---

[   ] KARMA TRITON CD-ROM Package (USA ONLY).......................$199.00 ________
(You must choose one of the shipping options below.)

[   ] Shipping via FedEx Ground, within the 48.....................................$15.00 ________
continental US states.

[   ] Shipping via FedEx Ground to Alaska,...........................................$20.00 ________
Hawaii and Puerto Rico.

Total charges (enter total):.................................................................................. ________

Shipping Address:
(Note: FedEx cannot ship to P.O. Boxes!)

[   ] Same as billing address above, or:

Street Address:___________________________________________________

City:____________________________________________________________

State, Province:___________________________________________________

Country:___________________________Post Code (Zip):_________________