Order form for Belkin ClassicMouse

Name:
Organization:
Address Line 1:
Address Line 2:
City:
State or Province
Postal code:
Country:
Phone:
Fax:
Email:

Quantity ordered (without Mbutton program):    ________
Quantity ordered  (including Mbutton program):  ________

The price for each Belkin ClassicMouse is $18.00. *
The price if ordered with Middle Mouse Button is $25.00. *
Diskette format if ordering Middle Mouse Button: 3.5"____ or 5.25"____

* Prices include shipping via UPS (ground) to US and Canada. 
  Add $5.00 for each mouse ordered if ordering from outside US or Canada.

Payment methods:
If paying by check or money order, payment should be in US funds.
Checks must be drawn on a US or Canadian Bank.
Make the check or money order payable to: Digital Control Systems.

We will also accept American Express, MasterCard or  VISA.
___ Check here to charge to your American Express account.
___ Check here to charge to your MasterCard account.
___ Check here to charge to your VISA account.

Name (as it appears on card):
Card Number:
Exp date:
Signature (if mailed or faxed):

If paying by credit card:
Use the secure on-line transaction server on our website, or if you prefer;
You may fax this form to 1-615-217-9149.
You may send this form to this email address :  cmouse@digconsys.com
You may also call us at: 1-615-217-9141 or 1-800-303-9396.
Or you may use our Postal mailing address (required for check or money order):

Digital Control Systems
1315 East Castle St. #D3
Murfreesboro, TN 37130-4545
USA