Please complete all fields and click the SUBMIT button. A representative from On-Line Data Corp. will contact you to confirm your order and payment options.

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First Name

Last Name

Company

Address

City

Prov/State

Postal/Zip Code

Country

Phone

Fax

E-mail Address

Primary Job Function

Which version(s) of QWiTS are you upgrading from?

v 1.0

v 2.0

v 3.0


QTY

AMOUNT


QWiTS 4.0 (US)

X $255 USD =

QWiTS 4.0 (Canadian)

X $357 CDN =

25% Discount for Current QWiTS Users (Please enter current serial number[s] separated with commas)

Subtotal


Canadian orders add 7% GST

Canadian orders add 8% PST


PST Exemption Number

TOTAL*

I do not wish to receive fax or email notifications from On-Line Data.

*Shipping costs will be calculated and added at time of order confirmation.