E-Z STABLE ORDER FORM (For orders within the U.S.)

CHAPMAN PET PROGRAMS - 1951 Hwy 61 - LORAINE, IL 62349

Phone:(217)696-2551 - Fax:(217)696-2802 - E-Mail:askme@ezkennel.com

You may print, complete and fax back, snail mail or scan & attach to an e-mail to place your order.

PLEASE SELECT (X) THE ITEM(S) YOU WISH TO ORDER

____$180.00, E-Z STABLE PLUS New Customer Price(One PC)$175+$5(S&H)= $180.00. (If installing on

a home network you must purchase a Network Station License for each additional PC on the network.)

____$130.00, E-Z STABLE STANDARD New Customer Price (One PC) $125.00+$5.00(S&H)=$130.00

(Must be a Registered User of a previous version).

____$25.00 Network Station License

____$15.00 DEMO CD (allows 10 uses of the full program within 10 days of installation. If you decide to

purchase the program you just pay the balance for the full program to get your registration code)

____$15.00 Replacement CD

____$5.00 Priority Mail (All orders are sent First Class Mail unless the additional $5.00 for priority mail is

selected.)

* = Required Fields

Business Name:

*First Name:

*Last Name:

*Address:

*City: *State: *Zip:

*Phone:( ) Fax:( )

E-Mail:

Method of Pmt: _____Money Order _____Check#:__________ (Allow 3-5 weeks for check orders)

By Credit Card (All fields below required.) _____Visa _____Discover _____MasterCard

Credit Card # :____________--____________--____________--____________

Exp. Date:_____/_____ Last 3 Digits on Back of Card: __ __ __

Name of Cardholder:

Card is Billed to: Address:

City, State, Zip:

*Total Amount (from above) to be charged: $________ . ____

I understand that all software purchases are final. This software is non-refundable and non-transferable.

*Actual Written Signature (required):____________________________________________________

If you have any questions or special needs please contact us before placing your order.