Fax Order Form

Ship To:
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  Last Name: 
    Company: 
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Bill To:
    Address: 
             
       City:  State:  Zip: 
    Country: 

      Email: 
      Phone:  
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Electronic E6-B for Palm OS: 0 1 2 3 4 5 @ $24.95 each (e-mail delivery)

Electronic E6-B for Palm OS Upgrade: 0 1 2 3 4 5 @ $12.95 each (e-mail delivery)

Electronic E6-B for Pocket PC: 0 1 2 3 4 5 @ $24.95 each (e-mail delivery)

Electronic E6-B for Pocket PC Upgrade: 0 1 2 3 4 5 @ $12.95 each (e-mail delivery)

Portable Electronic CoPilot for Pocket PC: 0 1 2 3 4 5 @ $49.95 each (e-mail delivery)

Additional Licenses: 0 1 2 3 4 5 @ $9.95 each (e-mail delivery only)

CD-ROM Delivery: 0 1 2 3 4 5 @ $5.00 each (select delivery method below)

Shipping Method: E-Mail delivery UPS Ground ($7, Lower 48 States) USA Only UPS 2nd Day Air, $15, USA Only UPS 2nd Day (AK, HI) , $24, USA Only UPS Next Day, $33, USA Only Other

Please email: sales@niborex.com for a FedEx shipping rate quote.

Notes: ___________________________________________ 

Florida residents add 7.5% sales tax.
Order Total (including shipping & handling): _________________

Card Type: VISA MasterCard American Express
Credit Card Number: Exp. Date:
Credit Card Number Security Code:

Signature _______________________________________