Data Tranz LLC
Data Systems for Business
PO Box 605 Valley City, ND 58072
Phone 888-488-8726	FAX ORDER

GlassShop Manager	

Fax toll free to:
1-800-316-5829	1.	Total your order.
2.	Fill out credit card information.
3.	Fill out company information.
4.	Fax form to: 1- 800-316-5829	

Quantity	Unit Price	DESCRIPTION	Extended Price	TOTAL	
1	239.99	GlassShop Manager	239.99	          239.99	
	SUBTOTAL	239.99	
	SALES TAX 
(ND Residents add 6% ($14.40))		
	Priority Mail & Handling	10.00	
	TOTAL		

Company Name_____________________________________________
Owner ____________________________________________
Address ___________________________________________
City ______________________________________________
State, Zip__________________________________________
Phone ____________________________________________
Fax ______________________________________________
Email Address
_________________________________________________

     Comments:	Credit Card Information

Circle:   Visa / MasterCard / American Express  

Name on Card                                                               .

Card #:                ___                                  __              .

Exp Date:                __                               ___              . 

Authorized by________________________________________                                                                                 

Date________________________________________________