dsSocket Order Entry Form Please ensure all information is correct before submitting your order. Incorrect order information will increase the turnaround time. For version update requests please use the Update Request Form. Billing Information: Name: Required Company: Address: Required City: Required Province: Required Postal Code: Required Country: Required Shipping Information: Same as above or: Name: Company: Address: City: Province: Postal Code: Country: Phone Number: Required Fax Number: Email Address: Required Product Selection: Enter the quantity of each item required. dsSocket OCX Developer License(s) (US$149) dsSocket OCX Source Code License(s) (requires OCX license) (US$349) Payment Information: For electronic payment we accept only PayPal Paypal Email Address : (eg:mypaypal@mydomain.com) A payment request will be sent to your PayPal account when the order is processed. Payment for all International or US orders not made by PayPal must be made in US Funds drawn on a US bank. Payment for all Canadian Orders must be made in US Funds drawn on a Canadian bank. Canadian orders must add GST (5%), Ontario orders must also add PST (8%). How did you find out about dsSocket? Link from other site Internet searching Magazine article, which Magazine? Other, please describe it: Dolphin Systems Inc. reserves the right to change prices without notice. Note:This information will be sent as an unsecured email message.