Please provide the following contact information:
(*required field)

*First Name
*Last Name
*Phone Number	- -
*E-mail
DCCPM Member ID Code
*Credit Card Type	American Express MasterCard Visa
*Credit Card Number
(No Space or Dashes in between Numbers.)
*Security # (from back of card)
*Expiration Date	01 02 03 04 05 06 07 08 09 10 11 12 Month 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year
*Name as it appears on the card
*Billing address for the card
Address 2
*City
*State	AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA MA ME MD MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WV WI WY
*Zip Code
(Product will be shipped to your billing address. If you require your order to be shipped to your business address, please fax a request on your organization's letterhead to 301-556-4243.)
PRODUCT SELECTION:
WordPerfect Office X3	Qty 0 1 2 3 ($100 each)
CorelDRAW Graphics Suite X3	Qty 0 1 2 3 ($110 each)
Paint Shop Pro Photo XI	Qty 0 1 2 3 ($84.50 each)
(You may purchase a maximum of 5 products.)
Sub Total:$
Sales Tax:$
Shipping:$
Total:$
All Sales Final. No Refunds, Returns, or Exchanges Will Be Allowed.
May Daly send you information on our government IT services at your business address?	Yes          No

Business address
Address 2
City
State	-- AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA MA ME MD MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WV WI WY
Zip Code

 

For questions or information on CPM Society Member Discount and other Corel products, see the DC Society of Certified Public Managers' website or call 301-670-0381 opt 2. Visit Daly