Specifications

TEL [phone] (toll-free)
FAX [phone]
Synapse
14 Lynn Court
San Rafael, CA 94901
Bill To:
Name
Company
Address
Address
City
State
Zip
Phone
E-mail _______________________________
FAX _______________________________
Ship To:
Name
Company
Address
Address
City
State
Zip
Phone
Credit card number
Expiration Date
Signature
VISA/MC/AMEX
Purchase orders with a $200 minimum are accepted from Fortune 500 fi rms
and academic institutions.
Please include $15 shipping and handling for individual software application
purchases. For more than one software item please contact us for freight
charges. Additional freights charges for AK, HI, Puerto Rico and Canada.
Contact us via email at: [e-mail] or order directly through
e-commerce at http://www.synapse-ada.com
Email address
Subtotal
Sales Tax
Shipping
Total
8.50% sales tax req. for CA sales
ORDER FORM
QTY MODEL# DESCRIPTION UNIT PRICE EXTENDED PRICE
E-COMMERCE ENABLED WWW.SYNAPSE-ADA.COM