Mail in / Fax in Order Form

Online Orders please visit:
http://www.mediamagnetpro.com/order.htm

To order Media Magnet Pro! offline, please complete the following form and send it to:


Mail to:
WebGrip, Inc

PMB 137
16420 SE McGillivray

Vancouver, WA 98683

Fax: 520-752-3587 (24 hours.)
Call: 360-833-2906 (weekdays 9:00am-5:00pm Pacific Time)
E-Mail:
sales@mediamagnetpro.com

1. Enter your name, shipping address and telephone number below:

Name   __________________________________________________


Company:  __________________________________________________


 Address:  __________________________________________________
 
  City:  ____________________ State: _________ Zip: __________


  Country:  __________________________________________________


  Telephone:  _____________________ E-mail: ______________________

I heard about Media Magnet Pro from: _________________________________________

2. Indicate the number of units and shipping method below:

___  Media Magnet Pro for Windows 95/98/2000/NT @ $ 149.95 ea. $_________
___  Media Magnet Pro database Update    @ $ 29.00 ea. $_________



TOTAL                $_________


3. Indicate the payment method below:

___  I've enclosed a check or money order payable to WebGrip Inc.
  (checks must be drawn in U.S. funds on a U.S. bank)
___  Please charge to my credit card:
  (Please include credit card billing address if different than shipping address above)

___ VISA ___ MasterCard ___ Discover ___ American Express


Card number: ___________________________________ Expiration date: ________

Cardholder's signature:  ____________________________________

© 2004 Media Magnet Pro - All rights reserved.