ACDSee/PicaView Image Viewer Order Form

Send to: ACD Systems               ACD Systems - Van Texas
         PO Box 730, Victoria  or  2201 North Collins  Suite 230
         B.C. Canada V8W 2P9       Arlington, TX, USA  76011
         FAX (604) 475-6651

Name___________________________________________ Date____________

Company________________________________________ Phone___________
                     
Street_________________________________________ FAX_____________

City__________________ Country_________ ZIP/Postal code_________

Email___________________________________________________________	

Product: (check one)   __ACDSee     __PicaView 

                ALL AMOUNTS ARE UNITED STATES DOLLARS
SINGLE USER LICENSE: 
 	License Only - NO Disk - NO shipping          =	$15.00
OR 	We ship one 3.5" registered disk (+ shipping) =	$30.00

SITE LICENSE:   Must supply a proper business name.
   3 to  9 computers 	@ $12.00 each X ____units     = _______
  10 to 29 computers 	@ $ 9.00 each X ____units     = _______
  30 to 99 computers 	@ $ 7.00 each X ____units     = _______
 100 &  up computers	@ $ 6.00 each X ____units     = _______
Site license disks 	@ $ 7.00 each X ____units     = _______

        Subtotal                                        _______
        Disk shipping (U.S. and Canada)	$4.95           _______
        Disk shipping (Other Areas)	$11.00          _______
        Texas residents add state tax:                  _______		

        Total (US funds only)                           _______

Method of payment:  Cheque__  Money order__  Mastercard__  VISA__

Name exactly as on credit card _________________________________

Card Number________________________________  Exp.Date___________

Signature_______________________________________________________