MED2000/32 Order Form

S E C T I O N S

Order Information
Phone:  (631) 474-0990
Fax:   Print this form and fax it to (631) 476-8875
Mail:  Send this form to JBS Inc.. PO Box 451 Port Jefferson NY  11777

Email  ndavella@jbsinc.com

Terms & Conditions

 50% Due at Contract Signing Next 50 % due at software activation.
 

Shipping Information

 All software shipped next day.


Order Form

Product

Item

Description

Price

Qty.

Total

Subtotal

Tax

Total

Style Line

Shipping Address

Name

Address

           

City

State

Country

Zip

Email


Billing Address
  Check if same as shipping address

Name

Address

           

City

State

Country

Zip

Email


Billing Information

Credit card

Name on Card

Card number

Expiration


 

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