Please print this form and follow the instructions below:
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DDH Software Order Form
Mail, Fax, or Phone to:

DDH Software, Inc.
PO Box 970971
Boca Raton, Fl 33497-0971
561-967-3668
Fax: 561-649-8012
email: sales@ddhsoftware.com
web: http://www.ddhsoftware.com
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First Name:____________________      Last Name:____________________________

Street
Address:_____________________________________________________________

City:________________________________________________________________

State:____________________ Zip Code:___________ Country:_____________

Day Phone: _______________________  Eve Phone:_______________________

Desktop Operating System____________________________________________

Current Handheld Device_____________________________________________

Email address*:_____________________________________________________
*Email Address REQUIRED to receive notice of future updates.

Registered User?:___________________________________________________
?If you are already a registered user please indicate the product
you are registered for and the email address you registered under.

Choose Payment Option:
[ ] *Check or *Money Order (enclosed) [ ] Credit Card
* Please make payable to: DDH Software, Inc.

Choose shipping option:  [ ] Via Email      [ ] Via Mail ($5 per application 
								 S&H *US Only, *Windows ONLY)

If Registering by Credit Card:
Check one:  [ ] Visa    [ ] MasterCard  [ ] American Express  [ ] Discover

Account Holder full name (as it appears on card) :
__________________________________________

Credit Card Account #:
_______________________________________________________________

Expiration Date (MM/YY): ___/___

Product(s) Available:
Enter the Quantity of each item you would like to register:
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Qty	 Description                   		Price (US $)   	Total
____  Translate + Danish Language			$12.00		$
____  Translate + Dutch Language			$12.00		$
____  Translate + Esperanto Language		$12.00		$
____  Translate + Finnish Language			$12.00		$
____  Translate + French Language			$12.00		$
____  Translate + German Language			$12.00		$
____  Translate + Hungarian Language		$12.00		$
____  Translate + Icelandic Language		$12.00		$
____  Translate + Indonesian Language		$12.00		$
____  Translate + Italian Language			$12.00		$
____  Translate + Japanese Language			$12.00		$
____  Translate + Latin Language			$12.00		$
____  Translate + Mandarin Language			$12.00		$
____  Translate + Norwegian Language		$12.00		$
____  Translate + Portuguese Language		$12.00		$
____  Translate + Spanish Language			$12.00		$
____  Hangman + Wheel of Treasure			$12.00		$
____  Thesaurus/Spellcheck				$15.00		$
____  HanDBase for Palm OS				$24.99		$
____  HanDBase for Pocket PC				$24.99		$
____  HanDBase Desktop(only) for Windows		$9.99			$
____  HanDBase Desktop(only) for Macintosh	$9.99			$
____  HanDBase Plus for Palm OS			$29.99		$
____  HanDBase Plus for Pocket PC			$29.99		$
____  HanDBase Conduit for Palm OS			$9.99			$
____  HanDBase ActiveSync Conduit
		for Pocket PC				$9.99			$
____  HanDBase Data Exchange
	     for Microsoft Access			$14.99		$
____  HanDBase Data Exchange
	     for ODBC					$29.99		$
____  HanDBase ODBC Driver for Windows		$49.99		$
____  HanDBase Sync Exchange FileMaker
		Conduit for Macintosh(MAC Only)	$29.99		$
____  HanDBase Printed Manual				$5.00			$
      (inc Shipping & Handling. 
	Shipped to US addresses only)
____  Children's Illustrated eTales			$9.98			$
____  HanDButton						$5.99			$
____  WineWizard						$00.00		$
____  Alticopeia						$12.99		$
____  HandEchart						$19.99		$
____  OB-On Call						$19.99		$
____  Patient HandChart					$139.99		$
____  Pocket Psychiatry					$29.99		$
____  Wound Care Manager				$495.99		$
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			Subtotal							$
			Less any Discount						$
			Shipping & Handling 
			($5 per Application
			PC compatible disk or CD)				$
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			Total amount						$

I authorize DDH Software, Inc. to charge the appropriate amount as noted above
for providing the appropriate software as listed above.  Software will be
shipped or emailed as noted above.  I understand that the software is
released as shareware and it is protected by copyright from illegal use
and/or copying.  I also understand that the software is released as is, and
that author is not responsible for any damages that may occur from the use
or misuse of this software.

Signature:_________________________________________ Date:______________

