RAMAS SOFTWARE ORDER FORM

Please fill out, print, and fax or mail this form. (instructions)

  Item Name License Type User Type Price
1 $
2 $
3 $
4 $
5 $
  Items   Software Total     $
New York customers add sales tax     $
Shipping and handling charges to:        $
Wire transfers & international money orders, add $20       $
Total     $
Name First
 Last
Organization
Billing Address
  Street
  City
   State/Province
  Zip/Postal Code
   Country
Shipping Address   Same as Billing Address
  Street
  City
   State/Province
  Zip/Postal Code
   Country
  Telephone*
   Fax*
  email*    
Credit Card Authorization  
Card Number
   Visa  Mastercard
Cardholder name
   Expiration Date
  /     /  
(month) / (day) / (year)
Daytime Phone*
   Signature

*in case we have a question about your order

Instructions:

Please fill out this form, print it, and email or fax it to us at:

Applied Biomathematics
100 North Country Road
Setauket, New York, USA 11733
Phone: (631) 751-4350
Fax: (631) 751-3435
email: info@ramas.com

Payment must be in U.S. Funds as:

  1. Visa or MasterCard
  2. Money order (international money orders please add $20 for bank charges)
  3. Check drawn from U. S. bank payable to Applied Biomathematics
  4. Wire transfer to our bank account (please call, fax, or email for details)
  5. Institutional purchase orders (please inquire if you need our federal ID#).
Shipping and Handling Charges
     
For single item orders: (regular/express)   For multiple item orders:
United States $10 / $15   Shipping charges may vary, based on weight and/or destination. Orders are typically shipped via UPS (within the continental US) and U.S. Postal Service for international orders. SHIPPING COSTS CAN BE VERIFIED IN ADVANCE BY CONTACTING US.    
Hawaii, Alaska and Canada $20 / $30
All other countries $30 / $45

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©2005 by Applied Biomathematics

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Date modified: 2/2008