Please print and complete this order form and fax or mail with payment information to the number or address below.  We will promptly forward your serial number and permanent registration code via email and fax.

Your Name: ___________________________________________________

Company Name: _______________________________________________

Address: _____________________________________________________

City: ________________________________________________________

State: __________________________  Postal Code: ________________

Phone: __________________________  Fax: _______________________

Email Address: ________________________________________________

(Note: Email address is used for registration and update notification).

Do you need a CD mailed to you?    £ Yes   £ No

Payment:   £ MasterCard    £ Visa    £ AmericanExpress    £ Check Enclosed

      £ Purchase Order (must be included, subject to approval)

Card Number: _______________________________  Expiration: ____ / ______

Name On Card: ____________________________________________

Authorized Signature: _______________________________________

Please fax or mail order form to:

Dealer Code: ___________

Express Technology

P.O. Box 372

Fairhope, AL 36533

Phone: 888-565-0127 or 251-929-3200

Fax: 888-891-8292 / 251-929-3211