# Kanji Safari
Order form

To use this form:

- print out this form directly from your web browser
- enter your postal address and email address
- select your preferred payment method
- fax or airmail this form with your payment to:

Lava Software, GPO Box 215, Adelaide, Australia, 5001
Fax: Intl. +61-8-8235-0668 Aust. (08) 8235 0668

Please print your details clearly in CAPITAL letters under each item below.

Name:

Street address / Post Office Box / Department:

Suburb / Educational Institution Name:

Town / City:

State / Province:

Post code / Zip code:

Email address ______________________________________

Number of licenses required at USD19.95 per license _______

Delivery method
( ) Download (download information will be emailed to you)
( ) Multi-platform CDROM (add USD15.00 for airmail delivery)
Note: Linux version will be available via download only

### Total amount: $ . . . . . . . . .

( ) Credit card ( ) International money order ( ) International bank check

( ) Visa ( ) MasterCard ( ) Bankcard ( ) American Express

Name on card: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expiry date: . . . . . . . / . . . . . . . .

Card number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . / . . . . . . / . . . . . . .

Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .