Order form for HTMLDocument Class Library - Please print and include with your order.

For Telephone orders:
Toll-Free: 1 800 999-2734
Regular: 1 (719) 576-0123

For FAX orders:
Regular: 1 (719) 623-0399

For Postal Mail orders:
RegNet (Wintronix, Inc.)
24303 Walnut Street, Suite 200
Newhall, CA 91321-2900
U.S.A.

A purchase order must be faxed or mailed to us with all necessary information including billing information.

User information:  (Note that email address is required)

First Name: ______________________________________________________________
Last Name: ______________________________________________________________
Company: ______________________________________________________________
Address line 1: ______________________________________________________________
Address line 2: ______________________________________________________________
City: ______________________________________________________________
State/Province: _____
Zip/Postal Code: ________________
Country: ______________________________________________________________
Phone number: ______________________________________________________________
Email address (required): ______________________________________________________________

Order information:

_______ Single License, Product ID: 10307, Unit Price: $99
_______ 4 Developers License Pack, Product ID: 10308, Unit Price: $189
_______ 10 Developers License Pack, Product ID: 10309, Unit Price: $299
_______ Site License, Product ID: 10310, Unit Price: $399
_______ Site License+Source Code, Product ID: 10311, Unit Price: $499

If you're paying with a credit card, please fill out the following information:

Name on credit card: ______________________________________________________________
Credit card type (circle one): Visa / MasterCard / American Express / Discover (Novus)
Credit card number: ______________________________________________________________
Credit card expiration date
(Month/Year):
_____/______