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CalendarWiz Order Form

Please print this form and fax or mail to CalendarWiz. Your calendar will be activated upon receipt.

______________________________________________________________

CalendarWiz, LLC
Tel:(603) 929-9592  
Fax:(603) 929-9754
Web: www.calendarwiz.com
Email: sales@calendarwiz.com

_________________________________________________________________________

Date: __________________

Select Product:

Qty: _____$88.00  Basic Edition (3) Categories / 25 registered users - Annual Fee 

Qty: _____$154.00 Standard Edition (8) Categories / 50 registered users -  Annual Fee

Qty:______$249.00 Professional Edition (20) Categories / 100 registered users - Annual Fee

$ ___________ Total

Contact Information:

Organization: _____________________________________________________________________

Contact Name: ____________________________________________________________________

Address: __________________________________________________________________________

City: ______________________ State: ______________ Zip Code:_________________________

Email Address: __________________________________ Phone: (           ) _________________

Website www._______________________________________________________________________

Important!  Provide Calendar Identifier:______________________________________________

Select Payment Method:

   Payment Method: Purchase Order  PO#_________________________
     Please attach Purchase Order if available.

   Payment Method: Credit Card
   A receipt will be sent to the above email address upon order processing.

Circle Card:  |  Visa  |  Master Card 

Credit Card Number: ____________________________________ Exp: Month _______Year_______

Name on Card (Exactly) _______________________________________________________________

Billing Address: _______________________________________________________________________

City: ____________________________ State: ____________ Zip Code: _______________________

Signature: ___________________________________________________________________________