AIM 96 Trial Version FAX Order Form

Name: ___________________________________________________________
Address: ___________________________________________________________

___________________________________________________________
City: _______________________________
State: _______________
Zip Code: _______________
Phone
Number:
_______________________________
Email:
(Optional)
___________________________________________________________
Credit Card:
   MasterCard     VISA     American Express     Discover 
Credit Card#: ___________________________________________________________
Expiration
Date:
____________________
Name on
Credit Card:
___________________________________________________________

Signature:

___________________________________________________________
Quantity: _________ ($7.95 Each for S&H - Valid for US and Canada Only)

Please FAX this completed form to (888) 398-6488 (Toll Free!)