Delfyn Software Offline Printable Order Form

This printable form is provided for offline orders sent by regular postal mail. Upon receipt of your order and payment,
we will send your Personal Registration Code by Email to register your program(s).

Name: _______________________________________________________________________
Address: _______________________________________________________________________
Address: _______________________________________________________________________
City: _________________________ State/Province: _____________ Zip Code:_________
Country: _________________________ Phone Number: ______________________________

Send My Personal Registration Code(s) to:
Email Address:
(please print clearly)		 ____________________________________Alternative Email: ____________________

— Check here if you would like your Personal Registration Code sent by postal mail to the address above.

Check the program(s) you wish to purchase:
  Title Price USD Amount Due
  4th of July Dreams Screensaver $8.95  
  A Christmas Tree Screensaver $8.95  
  Ballooneys Screensaver $6.95  
  By Water Screensaver $10.00  
  Coolscreams - A Halloween Screensaver $8.95  
  Dolphin Dreams Screensaver $10.00  
  Snowland Screensaver $10.00    
  Winter Dreams Screensaver $10.00 On Sale  
  Woodland Dreams Screensaver $10.00 On Sale  
 
Subtotal 
  
 
Washington State residents add 7.5% Sales Tax  
  
   
Total Amount 
  
Payment Method
___ Check or Money Order Payable to Delfyn Software
Orders outside the U.S., please send International Money Order
____ Credit Card
___ Mastercard   ___Visa    ___Diners Club
Card # ________________________________________ Expiration Date: __ __ /__ __ (MM/YY)
Cardholder's Name:______________________________ Zipcode:______________

Please mail this form along with payment to:

Thank you for your Order!

Delfyn Software
P.O. Box 421
Ione, WA 99139