Muddy Shoes | Fax/Mail Order Form

Fill out, print, and fax to (847) 381-7762 or mail to: Order Processing, Muddy Shoes Software, LLC, 342 Lageschulte St., Barrington, IL 60010, USA

Name:
Company:
Street Address:
Suite/Room Number:
City:
State/Province:	Zip Code
Country:
Telephone # (must have):
e-mail address:
Where did you hear of Visual Thunder?:

	Credit Card
	American Express Visa MasterCard
	Card # : Exp date:
	Name on Card:
	C.O.D. (add $5.00)
	Purchase Order # (must fax or mail also) :

Visual Thunder for Presentations Qty. Visual Thunder Multimedia Qty.	total # of units x $69.99 =
	TAX (Illinois Residents/Companies only) 7.75% =
	C.O.D. (if applicable) =
Shipping (please check one) Click HERE for more information on pricing & shipping.	Next Day Second Day Ground (3-4 days) International and/or multiple units of more than two. Muddy Shoes Shipping will calculate cost (if quote is needed, please call 1-847-381-3695.)
	TOTAL (leave blank if shipping cost is unknown)