Use this worksheet to order your purchases.  Please make sure to fill in all
required information in order to expedite processing.  Then, conveniently fax
your order to Comeau Computing at 1-212-412-9014.  You may email it as
well, so long as all the required information is provided.  Note that ALL
product parts are available electronically.  Shipping is electronic via
"FTP get".  We will normally provide you with the file name within 24 hours.

SHIP TO  (Do not specify a PO Box number, or just an email path):
Name/Title
Company
Address
Suite/Room/Dept
City/State/Zip                      Country
Phone number
Fax number
Email path (IMPORTANT!  PRINT CLEARLY)
Where did you hear of Comeau C++?

BILL TO (If different from SHIP TO information):
Name/Title
Company
Address
Suite/Room/Dept
City/State/Zip                      Country
Phone number

METHOD OF PAYMENT (REQUIRED):
* Credit Card (circle one):
 VISA MasterCard American Express Diners Club Carte Blanche JTC
Card# (required):                   Expiration Date (required):
Full Card Holder Name (required, print):
I have fully read the literature and do hereby authorize and
agree to this order and shipping charges (required signature here):
(A copy of the front and back of the credit card is requested.)
* Check (circle one): Company        Personal        Traveler's
(Checks must be in US dollars from a US bank.)
* PayPal SEE http://www.comeaucomputing.com/pp for instructions to pay with PayPal!
WE MUST OK YOUR ORDER WORKSHEET BEFORE YOU SUBMIT YOUR PayPal TRANSACTION.

YOUR ORDER (ALL FIELDS REQUIRED):
(1) Use full version/model number, note if for a beta version
(2) Which C compiler backend will you be using?  (3) a=ELECTRONIC
Product Description(1):
Operating System(1):
Your Machine(1):
Which C?(2):
Media(3):
Quantity:
Price:
Subtotal:
Shipping:
Sales Tax:
Total (required):
==> NY residents add sales tax.  All funds in US dollars. <==
All orders must be prepaid.  Attach PO/copy of credit card if applicable. <==

YOUR AUTHORIZATION (REQUIRED, EVEN IF SIGNED ABOVE):
Purchaser's Name + Title (print):
I have fully read the literature and license agreement, and I understand
the requirements of the product, and do hereby authorize and agree to this
order and shipping charges (authorized signature required):