Norsys - Mail Order Form

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Mail Order Form

Please print, fill out, and fax completed form to +1 604.221.2223 or mail it to the below address. Or instead, you may wish to use the online order form, or get info on submitting a purchase order.

Norsys Software Corp.
3512 West 23rd Avenue
Vancouver, BC, Canada V6S 1K5

Bill To:
Name	____________________________________
Organization	____________________________________
Street Address	____________________________________
	____________________________________
City	____________________________________
State/Province	____________________________________
Country	____________________________________
Zip/Postal Code	____________________________________
Email	____________________________________
Phone	____________________________________

Technical Contact:	(fill out if the primary user of Netica will be different from the above)
Name	____________________________________
Email	____________________________________

____ copies of Netica Application for Windows
	@ $785	$ ________
	or educational price @ $285	$ ________

____ copies of Netica API Programmer's Module
	@ $885	$ ________
	or educational price @ $285	$ ________

	____ for MS Windows
	____ for Linux
	____ for AIX
	____ other ______________


Subtotal		$ ________

Canadian residents only, add 15% HST (13% for ONT)		$ ________

Total (US $)		$ ________

All prices are in US dollars. Purchase price includes support by email and upgrades for one year (by download).

Special Instructions: (P.O. Number, VISA or MasterCard number and expiry, etc.):

________________________________________________________________

________________________________________________________________

________________________________________________________________