AccuBell Talking Caller ID
Mail Order Form

PLEASE PRINT LEGIBLY - If we cannot read the form we cannot process the order. Bold fields are required.

Product ID: 46614
Price: $19.95 (Georgia residents please include 7% sales tax)

Installation Number: _________________________

(Please get the Installation Number by going to 'Help Menu' and then select 'About' )

Quantity: _____ Date: ________________________

Full Name: _________________________________

Company Name: _________________________________

Billing Address: _____________________________

City: ____________________________

State/Province: _____________________

Zip/Postal Code: __________________

Country: _________________________

Phone Number: ______________________

Email Address: ______________________

Please be sure your email address is correct! This is how you will receive your confirmation and Registration code.

Type of credit card:

___ Mastercard/Eurocard    ___ Visa

___ American Express        ___ Discover

___ Check                       ___ Money Order

Card Number: ________________________

Expiration Date: ______________________


Please fill in the Form completely. If no credit card is specified then mail with a Check or Money Order, payable in US Dollars to:

REGSOFT CHECK PROCESSING DEPT.
9625 West 76th Street,
Suite 150, Eden Prairie,
MN 55344 USA