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Realfast, Inc.
P.O. Box 4700 • Frisco, CO 80443-4700
Sales/Customer Service: (800) 571-0277 • FAX: (970) 668-0268
Website:
www.realfast.com |
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Order Form |
| Number of Agents |
Annual Subscription Price
(New Customers Only) |
ORDER
(Enter Amounts Here) |
Annual Renewal Price
(Must Have Existing
Registration #) |
| 1 |
$95.00 |
|
$95.00 |
| 2 |
$180.00 (as low as $60.00 per agent) |
|
$155.00 |
| 5 |
$250.00 (as low as $50.00 per agent) |
|
$190.00 |
| 10 |
$390.00 (as low as $39.00 per agent ) |
|
$280.00 |
| 11 or more |
$495.00 (example: $20 per agent for 25 agents ) |
|
$375.00 |
| Company Logo |
$150.00 |
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Logos NOT available for: PA, HI, WI, TX and in some parts
of VA |
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*This price does NOT include
a CD; we recommend
get the latest version of our product from our website. If you must
have a CD,
please call 1-800-571-0277
for pricing. |
TOTAL |
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| Software Licensed To |
(Enter information EXACTLY as you want it to appear on
your contracts) |
| Registration Number (Required for renewals) |
IMPORTANT NOTE:
Fields with an * are required. Most of this information will be used
to install the software, and will appear in contracts you create. Your
E-mail address will be used to notify you of forms and software updates. |
| *Licensed To Name: |
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| *Company Name: |
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| Company Line 2: |
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| *Address: |
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| Address Line 2: |
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| *City: |
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| *State |
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| *Zip |
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| *Phone: |
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| Fax: |
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| *E-Mail: |
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| Mailing Address |
(For Mailing using the U.S. Postal Service) |
Same as Licensed To
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| Attention: |
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NOTE: Please check one of the “Same as” boxes
or fill out ALL the information. |
| *Address: |
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| Address Line 2: |
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| *City |
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| *State |
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| *Zip: |
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| Payment Information |
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Payment Type
(check one) |
Visa
Master Card
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American Express
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Check
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| Credit # (please use dashes: |
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Expires: |
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| Name on Card: |
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| Other Information |
| How did you hear about Realfast?: Magazine Ad
Convention
Referral
Direct Mail
Other
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| Please specify which magazine, convention, who referred
you and/or explain "other": |
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FAX with Credit Card Info to: 970-668-0268
-or- MAIL with Check or CC info to: Realfast, Inc. PO Box 4700, Frisco,
CO 80443
Thank you for your order — we appreciate your business. |
©2006 Realfast, Inc. |