RTG E-Bills Order Form

Print this page using your Web browser. Fill out the form and write a check payable (in U.S. dollars) to RTG Data Systems. 		Mail the form and your check to:

RTG Data Systems
2118 Wilshire Blvd., #291
Santa Monica, CA 90403
We will send the program CD to the following address:
        Your Name:  ____________________________________________

        Firm Name:  ____________________________________________

          Address:  ____________________________________________

                    ____________________________________________

City, State*, ZIP:  ____________________________________________

           E-mail:  ____________________________    Fax:  __________________
Note: RTG E-Bills will only be shipped by mail within the United States.

Please supply your e-mail address and fax number in case we have questions about your order. If you have questions for us, send e-mail to RTG.

Indicate below the items you wish to order. Prices are in U.S. dollars. 

Description                Quantity  x  Unit Price  =  Amount
_________________________________________________________________

RTG E-Bills                  ____         $199        __________


                                          Subtotal:   __________


                                        *Sales Tax:   __________


Shipping is free!                        Total Due:   __________
*You must add 8.25% sales tax for shipment to any California address. Do not include tax on shipments outside California.