Order Form for CurlStat

To order CurlStat by mail, use the form below,
and send a cashiers check, money order or
personal check made payable to Ralph Roza to:

Ralph Roza
1015 S. 220th St
Elkhorn, NE 68022
USA
ATTN: CurlStat

To order by mail:

          Order Form

        Mail money order or cashier's check or personal check

        in U.S. or Canadian funds to:

                        Ralph Roza

                        1015 S. 220th St

                        Elkhorn, NE, 68022

USA

                Email inquiries: rozaralph@cox.net

                Voice inquiries: 402 763 9152

Use this form or any facsimile that includes this information.

Name:___________________________________________________________

Address:________________________________________________________

City:___________________________________________________________

State/Province:_________________________________________________

Zip:____________________________________________________________

Phone:__________________________________________________________

Price: New order;                    $80.00 U.S. or equivalent $CA.

Price: Upgrade from Version 5;       $40.00 U.S. or equivalent $CA.

Price: Upgrade from Version 4;       $60.00 U.S. or equivalent $CA.

If upgrade, Number from Version 5. ______________________________

If upgrade, Unlock Code from Version 5. _________________________

If upgrade, Number from Version 4. ______________________________

If upgrade, Unlock Code from Version 4. _________________________

+Shipping: (from below)                             ____________

        Regular Mail;                           ( $3 U.S.)

        3/4 days (Canada/U.S.);                  ($5 U.S.)

        FedEx (Canada/U.S.);                    ($25 U.S.)

        Priority (outside Canada/U.S.)          ($10 U.S.)

                                                 TOTAL:$_________