BMT Micro Printable Order Form

Brain Block Interactive/BMT Micro Printable Order Form
Order by mail using a Check or Money Order,
or order by Fax using one the acceptable payment methods shown below.
Click to Print This Page

**Please see the bottom of this form for important information**

Please use the Print button in your browser to print this form. Fill out the printed form, and then send or fax it with your payment to: Voice Orders: 9:00 am - 5:30 pm EST (-5 GMT)
(800) 414-4268 (orders only)
(910) 792-9100
BMT Micro
PO Box 15016
Wilmington
NC 28408
Fax: 910-792-1889

Name (Please Print)

Address

City State / Province

Zip / Postal Code Country

Phone #

Fax #

E-Mail Address

Alternate E-Mail

Payment Method (circle): CASH   /   CHECK   /   MONEY ORDER   /  DEUTSCHE BANK
                                      VISA   /   MC   /   DISCOVER   /   AMERICAN EXPRESS
                                      DINERS CLUB   /  CARTE BLANCHE   / JBC / EUROCARD

** Please make check or money order payable to "BMT Micro"
** All checks or money orders in US Funds only

Please add the following information for credit card orders:

Card# _________________________________ Exp. Date: ____ / ____

EXACT Name on Card: _________________________________________

Signature ____________________________________________________

Important Ordering Information

Ordering and general ordering questions:
Via Email: bmt@bmtmicro.com

We accept Visa, Mastercard, Discover, American Express, Diners Club, Carte Blanche, Cashiers Check, Personal Check. Personal checks are subject to clearance. Euros, Sterling, and US Currency is welcome but please send by registered mail, return receipt requested. We cannot be liable for lost cash sent through the mail

If you reside in a country with an unconvertible currency please contact us for alternatives.

Purchase orders are welcome, subject to approval. The minimum amount is $250.00 US.

ORDERING FROM INSIDE EUROPE ONLY
=================================

Persons in Europe wishing to order shareware may also transfer funds into our account with Deutsche Bank. Once the money is deposited you may either fax a confirmation to us with proof of deposit or wait until Deutsche Bank notifies us of the transaction (usually 10-18 business days). Account information is as follows:

Deutsche Bank / Frankfurt Branch
Empfänger: Thomas Bradford
Konto-Nummer: 0860221
Bankleitzahl: 500-700-10

When you make the transfer, be sure to put your name and the program you are registering on the transfer.

It is very important that you send us a completed order form by either email or fax if you deposit money into this account for a registration. Fill the order form out as usual except in the credit card number field put "DEUTSCHE BANK". We will file the order and use it to match against the deposit information we receive from the bank.

IMPORTANT!
----------
When you fax or mail us your order form, we will reply to the email address above with an acknowledgement. If you do not get an acknowledgement within 7-10 business days for mail orders, please send your order again in case it was lost.This extra bit of caution can save a lot of confusion.

If you are concerned that your order is taking too long to process, feel free to check with us about the status of your order. It's important to all of us that you feel safe doing business with our company and please feel free to suggest ways we can improve our service to you.

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Return to Brain Block Interactive

Item Description	Price Each	Quantity	Price
Bloink	$11.95
Arcade Mah Jongg Gold	$11.95
Super Bubbles	$11.95
Logication	$11.95
Games on CD ROM (Order as many games as you like and for an additional $10.00 we will put them on a CD).	$10.00
Shipping Cost (See below for options)**
North Carolina Residents please add 6.5% sales tax
Total Amount Enclosed

Brain Block Interactive/BMT Micro Printable Order Form Order by mail using a Check or Money Order, or order by Fax using one the acceptable payment methods shown below. Click to Print This Page Please see the bottom of this form for important information
Please use the Print button in your browser to print this form. Fill out the printed form, and then send or fax it with your payment to:	Voice Orders: 9:00 am - 5:30 pm EST (-5 GMT) (800) 414-4268 (orders only) (910) 792-9100	BMT Micro PO Box 15016 Wilmington NC 28408 Fax: 910-792-1889

Name (Please Print)
Address
City		State / Province
Zip / Postal Code		Country
Phone #
Fax #
E-Mail Address
Alternate E-Mail