ANTEQ MAIL IN ORDER FORM
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Desired Item(s):

[] Anteq Mall Manager - Single User Version [$495.00 USD]
[] Anteq Mall Manager - Multiple User Version [$595.00 USD]
[] Anteq Dealer Manager - Single User Version [$325.00 USD]
[] Anteq Dealer Manager - Multiple User Version [$395.00 USD]
[] Anteq Retail Manager - Single User Version [$275.00 USD]
[] Anteq Retail Manager - Multiple User Version [$325.00 USD]
[] Anteq Collection Manager [$79.95 USD]

Please fill out the following form (please print):

First Name:______________________________________________

Last Name:_______________________________________________

Address:_________________________________________________

City:_______________________ State/Prov: ________________

Zip/Postal Code:____________ Country:____________________

Phone:(___)_________________ e-mail:_____________________

Please send the completed form with payment to:

AKalfon Enr
160 Lakeview Blvd.
Beaconsfield, Quebec
Canada
H9W 4S4

IMPORTANT - Please make all cheques out to: Akalfon Enr.