Source Insight Order Form

Source Dynamics, Inc.
22525 SE 64th Place, Suite 260
Issaquah, WA 98027 USA
1-800-552-2231
http://www.sourceinsight.com

Fax Orders To:
1-(425) 557-3631 

Ship To:

(Please Print) Name ________________________________________
Company Name ________________________________________
Address1 ________________________________________
Address2 ________________________________________
City, State, and Zip ________________________________________
Phone ________________________________________
Fax ________________________________________
Email ________________________________________

Quantity

  

Price Each

Total
_______ Source Insight 3.5 Program Editor
(3.5" for Win7/Vista/XP/2000)		 US $249 ________
_______ Source Insight 3.5 Upgrade
(3.5" for Win7/Vista/XP/2000)
Serial Number(s): _____________________________
___________________________________________
___________________________________________
___________________________________________		 US $99 ________
_______ Shipping & Handling - see below for prices.
(for 2 or more, call for pricing)		 ________ ________
  Add 8.8% Sales Tax (Washington state only) x 8.8% ________
    TOTAL: ________

Prices quoted are for a license for use on a single computer. Quantity discounts start at 10 units for $219 each + shipping and handling. Prices are subject to change without notice.

Shipping and Handling:

____ FEDEX Ground $9 ____ FEDEX 2-Day $21
____ FEDEX 1 Day $35
____ International Order 
(prices quoted individually)		 ____ Alaska or Hawaii - Add $10

Payment Method

_____ Check or Money Order enclosed (Must be US funds)

_____ I authorize Source Dynamics to charge my credit card account for this purchase.

____ Visa ____ Mastercard ____ American Express

Card #: _________________________________________ Expiration Date: _______

Name on card: ___________________________________________________________

Signature: ______________________________________________________________

Thank you for your order!