JoMail/9 Elder Inc.
Credit Card Order Form

You can place MasterCard, Visa, Discover, Diner's Club, and American Express orders through
9 Elder Inc. Send faxes to 303 271 0109 and email to sales@jomail.net. Mail orders to 9 Elder Inc, PO Box 281,
Durham NH 03824, USA. All prices are in US Dollars.

Standard license fees:

JoMail         ____ licenses (1 to 5) at $19.95 each                   = ______
               ____ licenses (6 to 100) at $16.75 each                 = ______
               ____ licenses (101 or more) at $13.90 each              = ______


Educational license fees (requires name of educational institution)

JoMail         ____ licenses at $14.95 each                            = ______


                                                           Total payment ______


Name: ____________________________________________________ Date:___________
Company: __________________________________________________________________
Address: __________________________________________________________________
City, State, Zip: _________________________________________________________
Country: __________________________________________________________________
Day Phone: ______________ Eve: _________________
Electronic Mail address: __________________________________________________
Name of Educational Institution: __________________________________________


Credit Card [ ] MasterCard [ ] VISA [ ] AMEX [ ] Discover [ ] Diner's Club

Credit Card Number: _____________________________________
Expiration Date:    _____________________________________
Name On Card:       _____________________________________
Billing Address:    _____________________________________
                    _____________________________________
                    _____________________________________



Terms and conditions subject to change without notice. JoMail is a trademark of 9 Elder Inc.