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: ___________________________________________________

Organization Name: _______________________________________________

Address: _____________________________________________________

City: ________________________________________________________

State: __________________________  Postal Code: ________________

Phone: __________________________  Fax: _______________________

Email Address: ________________________________________________

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

Payment:   __MasterCard    __Visa    __AmericanExpress    __Check Enclosed

      __Purchase Order (must be included, subject to approval)

Card Number: _______________________________  Expiration: ____ / ______

Name On Card: ____________________________________________

Authorized Signature: _______________________________________

Express Technology

P.O. Box 372

Fairhope, AL 36532

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

Fax: 251-929-3211