Fax & Mail Form


	ediSys Corp. Fax and Mail Form


	Please complete the following information and return it to ediSys via:

Fax:
(214) 853-5761
Phone Orders:
(214) 853-5761

Mail:
ediSys Corp., Attn: Sales
PO BOX 12687
Dallas, TX 75225


	1) Product Information

Product	Price	Quantity	Total
eFTP Explorer	$19.95	____________	____________
eNotepad	$19.95	____________	____________
ePassword Keeper	$19.95	____________	____________
eSpace Analyst	$9.95	____________	____________
eView	$29.95	____________	____________
eWords	$19.95	____________	____________
eZip Wizard (95/98/NT)	$29.95	____________	____________
eZip Wizard (16 bit)	$29.95	____________	____________

Subtotal:	____________
Tax:*	____________
Total:	____________


	*Note: ediSys is required by Texas law to charge 8.25% tax on all sales.


	2) Payment Information (Billing address required for credit card transactions.)


	first name: _________________ last name: _____________________________ phone: _______________________ x______ Fax: _______________________________________ e-mail: ___________________________________________________________

	Visa		Discover
	Mastercard		American Express


	credit card number: ____________________________ exp date: ____/____/____ name: _______________________________________ (if different than above) address 1: _______________________________________ city: __________________________________ state: __________________________________ country: __________________________________ postal (zip) code: ___________


	3) Method of Registration Code Delivery

	Fax (sent to the number provided above)
	e-Mail (sent to the address provided above)