Order form for Wpf-Ribbon Library

For phone orders using your corporate credit card:
Call: 1-248-686-1982
For FAX orders:
Fax to: 1-323-316-9612

For Postal Mail orders:
DevComponents LLC
24312 Knollwood
Novi, MI 48375
U.S.A.

A purchase order must be faxed or mailed to us with all necessary information including billing information.

User information:  (Note that e-mail address is required)

First Name, Last Name: ______________________________________________________________
Company: ______________________________________________________________
Address line 1: ______________________________________________________________
Address line 2: ______________________________________________________________
City, State, Zip/Postal Code: ______________________________________________________________
Country: ______________________________________________________________
Phone number: ______________________________________________________________
E-mail address (required): ______________________________________________________________

Order information:

_______ Single License, Unit Price: $249
_______ 4 Developers License Pack, Unit Price: $697
_______ 10 Developers License Pack, Unit Price: $1494
_______ Single License w/ source code, Unit Price: $299
_______ 4 Developers License Pack w/ source code, Unit Price: $837
_______ 10 Developers License Pack w/ source code, Unit Price: $1794
_______ Site License w/ source code, Unit Price: $1999

If you're paying with a credit card, please fill out the following information:

Name on credit card: ______________________________________________________________
Address on file with credit card company: ______________________________________________________________
City, State, Zip/Postal Code, Country: ______________________________________________________________
Credit card type (circle one): Visa / MasterCard / American Express / Discover (Novus)
Credit card number: ______________________________________________________________
Credit card expiration date
(Month/Year):
_____/______
Yes, I authorize DevComponents to charge amount above: _______________________________________
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