To
Sign Up for our Distributor Program please complete this form below.
You will then be given the opportunity to instantly create your "Mirror
CheckMAN web site".
Name:
E-Mail:
Company:
Street Address:
City, State, Zip:
,
Phone:
Fax:
Are You currently a CheckMAN User?
If you need to purchase your copy, please complete all "RED
FIELDS". If you already have a copy of CheckMAN Click
Here to choose your Distributor Options.
Your Own Product
Options:
CheckMAN Ordering Options
Sales TAX (Illinois
Residents only)
Please Select From Options Box
Shipping Options
(Please Select One)
Please select S/H method:
(AirBorne Shipped Daily M-F)
(USPS Shipped on Tues. & Fri.)
TOTAL
AMOUNT AUTHORIZED For Your Copy of CheckMAN Only
TOTAL= (Price+Shipping+Tax (if
IL Resident))
Distributor
Options
Website Option:
Standard Version Diskette Ordering Options:
**A minimum of 10 Copies are required for "Option A"
Distributors.
Standard Version w/300 Checks(Retail: $49.95)
PRO Version w/300 Checks (Retail: $84.95)
CheckMAN COMBO PACKAGES
Combo
A: $107.00 ($100 + $7 s/h)
(Retail Value $480.35)
10 Copies Standard Version (Retail $29.95 ea)
2 Standard Version w/300 checks (Retail $49.95 ea)
1 Pro Version w/300 checks (Retail $84.95)
Combo
B: $225.00 ($218 + $7 s/h)
(Retail Value $1,168.40)
25 Copies Standard Version (Retail $29.95 ea)
5 Standard Version w/300 checks (Retail $49.95 ea)
2 Pro Version w/300 checks (Retail $84.95)
Combo
C: $455.00 ($435 + $20 s/h)
(Retail Value $2,417.75)
50 Copies Standard Version (Retail $29.95 ea)
10 Standard Version w/300 checks (Retail $49.95 ea)
5 Pro Version w/300 checks (Retail $84.95)
Autoresponder:
Tri-Fold Brochures:
Camera Ready Sales Aids:
Special Dealer Packages:
Custom Demo:
Distributor Total:
$ Please total all the Distributor Options in this box.
Comments:
Payment Type
MasterCard Visa AmEx Online
Check
Amount Authorized to be charged or Drafted: $ (Please add the Distributor Total and the Total
Amount for your own copy of CheckMAN in this box. If the total
is $0.00 please enter it here.)
Credit Card Info
Credit Card number:
Expiration Date:
Name on Card:
Billing Address + Zip Code
Online CHECK Info (USA only)
Name On Check
("A" from above)
Check Address, City, State:
("A" from above)
Bank Name:
("B" from above)
Bank City & State:
("C" from above)
Check Number:
("D" from above)
A.B.A. Fraction:
("E" from above)
Routing Number (9 Digits):
("F" from above)
Account Number:
("G" from above)
All Numbers From Bottom of Check:
(see instructions below)
This is Redundant, but itwill
insure accuracy.
By submitting this form, you are giving Nelson
Publications permission to draft your checking account, or charge your
credit card in the amount listed in the form above. Any check returned
for insufficient funds is subject to a $25 service fee. By typing
my Full Name in this box,
I agree to these terms.
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