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Via Fax: 1-305-947-0045
Or Mail to:
0-0 DataNetwork
16950 North Bay Road, Suite 801
North Miami Beach, FL 33160 USA
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*Name:
*Company Name:
*Shipping Address:
*City:
*State/Province:
*Postal Code :
*Country:
*Telephone:
*Fax:
*Email Address:
Card Type: MasterCard [ ] Visa [ ] AmEx [ ] Discover [ ]
*Credit Card Number:
*Expiration Date:
I authorize 0-0 DataNetwork to charge my credit card for the Product(s):
*Product Name:__________________________ *Price: $ __________
Shipping/Handling: $9.00 - USA Regular [ ]; $15.00 - USA Overnight [ ];
$10.00 - Overseas Regular [ ]; $30.00 - Overseas Express [ ]; Email - $0.00 (File size: less than 100,000 records) [ ].
*TOTAL ORDER: $ ___________________
*Signature:
*Date:
*Name as appears on Card:
*Billing Address:
*City, State & Postal Code:
A CHECK payment delays your shipment by 5 Business Days for Clearance.
Please fax the completed form to 1-305-947-0045
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