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   PerCon Product Ordering Info

Use the form below to place an online order for the selected PerCon CD-ROM. All fields marked with an asterisk (*) must be filled in. However, customers who do not wish to transmit their credit card information over the internet can call PerCon at (716)386-6015 to place an order by phone. Customers can also print and complete a copy of this form and fax it to PerCon at (716)386-6013.

Once a complete order is received, an order confirmation will be provided along with the order total. Customers should receive their order within 2-3 business days. All prices include 2-day shipping. Sales tax is only applicable to New York state residents.

 
   PerCon Product Order Form  

Customer Information

Name:*                  
Company Name:   
E-Mail Address:* 

Contact Information

Address (Line 1):*
Address (Line 2):  
City:*                     
State:*                                    Zip:*    
Country:*                  (US & Canada only)
Contact Phone:*       Fax:

Billing Information

Credit Card #:*     (Visa, Amex, Master Card only)
Expiration Date:*

Item #1 *  Qty *

Item #2     Qty   

Item #3     Qty   

Item #4     Qty