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
Easter Egg Screensaver	$ 8.95
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 28461
Spokane, WA 99228