Secure Data Entry and Credit Card Form

Prices and terms are listed on the ordering page. To process an order by credit card you will need to provide the following information: This information may be sent on this secure page or by Fax or phone (see contact tab). If you need a formal quote use the contact tab to request one before you place the order.

None of this information is kept on line and none of this information is used for any purpose other than this transaction and for software update notices.

Billing Information:

Credit Card information is processed at the time of shipping. The invoice (marked “PAID”) and the credit card receipt will be e-mailed as a two page PDF file attachement to the billing contact unless otherwise instructed below. The registration information will be e-mailed to the registered user (below).

	Purchase Order number, if any:
	Credit Card Type (MasterCard, Visa, AmEx):	•
	Credit Card Number:	•
	Expiration Date:	•
	Name exactly as printed on the Credit Card:	•
	Card verification number: (3-digit number on the rear of the card after the credit card number. AmEx uses a 4-digit number on the front over the card number)	•
	Address to which the credit card bills are sent: For personal card this will be a home address. Must have accurate street and Zip code data if in the USA.	•
	Credit Card Holder’s Phone number:	•
	Credit Card Holder’s e-mail address:	•
	Send Invoice/Receipt to this e-mail? If not, should these be in the shipping package or mailed directly to you?

Shipping Information:

	Company
	Name:
	e-mail address:
	Mailing address:
	Phone number: (needed by shippers)
	Shipping will be by UPS or FedEx, using the best method to meet your needs. If you have special instructions, including the use of your shipping account number, enter here.
	Is the shipping address a residence (different rates apply)?		Yes No
	Do you require an adult signature (additional charge applies)		Yes No

Software Registration:

This information will be used to notify the software user of download information, upgrades and new passwords for Tac32, Tac32Plus or other software.

	Name:
	e-mail address:
	Mailing address:
	Phone number:
	If this order includes one or more CNS Clocks and would like the default IP adress in each clock set to a custom value, enter values here. The default is 10.10.10.190 followed by .191, .192, etc.

Order Information:

This is not an order form or a replacement for a Purchase Order but it is useful to confirm the basic information in the order to assure that the materials billed to your card are what you expect. You should ask for a formal estimate or ProForma invoice to get the complete order information.

	Confirm the quantity and part number: (CNSC01A, Tac32, Tac32Plus, etc.)
	Confirm the total price:
	Shipping charges will be added to the credit card when known. OK?	•

Submit or Cancel:

	Comments: Include any special comments here.