Fax to
910-792-1889
Mail to
BMT Micro
PO Box 15016
Wilmington
NC 28408

BMT Micro Order Form

 V - The File Viewer

Order Details

I want to purchase a single user license for V @ $20

I want to purchase a site license for the following number of users (enter the number of users in the appropriate section). 

  .......  2-9  users @ $20 each    ....... 50-99 users @ $11 each

  ....... 10-24 users @ $17 each    ....... 100-499 users @ $8 each

  ....... 25-49 users @ $14 each    ....... Unlimited License (Single Site) - $4,000

                                    ....... Unlimited License (National)    - $6,000

Total value of order   $________     ___ Tick here if you are a registered user who is upgrading.
                                            If you are, please take 15% off the order total, and include
                                            your current Registered User Name in the field below.
[All amounts are in $US]
[Residents of North Carolina will be charged the relevant sales tax]

Registration Details

Name (First/Last)    ......................................................

Company name         ......................................................
(if applicable)

Address              ......................................................

                     ......................................................

City                 ......................................................

State/Province       ....................  Zip/Post Code  .................

Country              ......................................................

Email address        ......................................................

Contact Phone #      .........................  Fax# ......................

Registered User Name    .................................................
                         (This is the name that will appear on the About Box)

Payment Details

Check/Money Order attached (made out to BMT Micro), or 
Credit card number
(MC, Visa, Amex, Discover)    .............................................

Expiration Date (MM/YY)       ............


Signature                     .............................................
Complete the following section ONLY if DIFFERENT from the above name/address.

Credit Card Holder's Name & Address

Name on Credit Card  ......................................................

Company name         ......................................................
(if applicable)

Address              ......................................................

                     ......................................................

City                 ......................................................

State/Province       ....................  Zip/Post Code  .................

Country              ......................................................
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