PREDICTPlus ORDER FORM

Name on Credit Card:
Company:
EMail:	Confirmation will be emailed
Billing Address:
Billing City:
Billing State(US and Canada):	AK Alaska AL Alabama AZ Arizona CA California CO Colorado CT Connecticut DC District of Col. DE Delaware FL Florida GA Georgia HI Hawaii IA Iowa ID Idaho IL Illinois IN Indiana KS Kansas KY Kentucky LA Louisiana MA Massachusetts MD Maryland ME Maine MI Michigan MN Minnesota MO Missouri MS Mississippi MT Montana NC North Carolina ND North Dakota NE Nebraska NH New Hampshire NJ New Jersey NM New Mexico NV Nevada NY New York OH Ohio OK Oklahoma OR Oregon PA Pennsylvania PR Puerto Rico RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VA Virginia VI Virgin Islands VT Vermont WA Washington WI Wisconsin WV West Virginia WY Wyoming N/A Not Applicable AB Alberta AS American Samoa BC British Columbia GU Guam MB Manitoba NB New Brunswick NF Newfoundland NS Nova Scotia NW Northwest Territory ON Ontario PE Prince Edward Island PQ Quebec PR Puerto Rico SK Saskatchewan VI Virgin Islands YK Yukon Territory
Billing Postal Code:
Billing Country:	United States Argentina Australia Austria Belgium Brazil Canada Chile Columbia Czech Republic Denmark Egypt England (U.K.) Finland France Germany Greece India Ireland Israel Italy Japan Mexico Netherlands New Zealand Norway Peru Portugal South Africa Spain Sweden Switzerland Turkey Venezuela
Home Phone:		Day Phone

Shipping Address:(if different):

Name:
Company:
Shipping Address:
Shipping City:
Shipping State(US and Canada):	AK Alaska AL Alabama AZ Arizona CA California CO Colorado CT Connecticut DC District of Col. DE Delaware FL Florida GA Georgia HI Hawaii IA Iowa ID Idaho IL Illinois IN Indiana KS Kansas KY Kentucky LA Louisiana MA Massachusetts MD Maryland ME Maine MI Michigan MN Minnesota MO Missouri MS Mississippi MT Montana NC North Carolina ND North Dakota NE Nebraska NH New Hampshire NJ New Jersey NM New Mexico NV Nevada NY New York OH Ohio OK Oklahoma OR Oregon PA Pennsylvania PR Puerto Rico RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VA Virginia VI Virgin Islands VT Vermont WA Washington WI Wisconsin WV West Virginia WY Wyoming N/A Not Applicable AB Alberta AS American Samoa BC British Columbia GU Guam MB Manitoba NB New Brunswick NF Newfoundland NS Nova Scotia NW Northwest Territory ON Ontario PE Prince Edward Island PQ Quebec PR Puerto Rico SK Saskatchewan VI Virgin Islands YK Yukon Territory
Shipping Postal Code:
Shipping Country:	United States Argentina Australia Austria Belgium Brazil Canada Chile Columbia Czech Republic Denmark Egypt England (U.K.) Finland France Germany Greece India Ireland Israel Italy Japan Mexico Netherlands New Zealand Norway Peru Portugal South Africa Spain Sweden Switzerland Turkey Venezuela

All US transactions will be sent Fed EX at $16.00 per order or Download from the Web for no charge ($0.00). Foreign Countries have a choice but we suggest Federal Express because it is more reliable and traceable or web download. If your country is not included in the list please email us Email Us (dragontech@comcast.net). Check Table for foreign Rates

Federal Express US Express Air Mail US Standard Air Mail Web Download

PredictPlus Standard Version ($299) Quantity:	1 0 2 3 4 5 10

PredictPlus Update ($199) Quantity:	0 1 2 3 4 5 10
Previous Serial # Required:

No charge for American Express. There is a 3.5% handling charge for VISA, Master Card or Discover.

American Express VISA Master Card Discover

Credit Card #:		Expiration Date:

Please Fill out order form and Press Calculate to send us your credit card information securely. This information will be used for this transaction only. We will not distribute your name to anyone else.