Fax Order Form for Phone Dialer Pro (SWREG # 146738003)

To order by fax using a credit card, please print out this document, complete it and fax to Soft Shop.

Following are our fax numbers - all are toll free unless marked with a *.
If your country is not listed please fax to the USA number +1 (866) 219 9380

USA  (888) 219 9380 (toll free)       
Canada (866) 723 3438 (toll free)
United Kingdom
+44 1159 541111*

Australia 1800 013971
Belgium use UK number
Finland 0925 360011 *
France 0800 917034
Germany 0800 1808295
Ireland 1 800 509147
Italy 800 781703
Netherlands use UK number
New Zealand 0508 555300
Portugal 800 844030
Spain 900 95 8968
Switzerland 0800 835132
Sweden 0207 94125
UK +44 1159 541111*

Ship-To Name & Address:

First/Middle Name:
Last Name:
Company name:




Phone + Fax
Your email address - in capitals:
Card number (MC, Visa, Amex, Discover, Switch, Delta, Eurocard, Diner's):

Expires- Month: Year::

Start Date (Diners only):
Issue Number (Switch only):


Credit Card Holder's Name & Address for verification: Do NOT enter the BANK's name or address in the fields below. Enter the address where the cardholder receives the statements. (Only fill out the spaces below if the credit card holder's name or address is DIFFERENT from the Ship-To name and address entered in the spaces above.)

Name on the card:
Company name:
(if different to above)




Order Details





xxxx option a


xxxx option b


xxxx option c



Fax handling fee:




Shipping and handling: jkozl@altavista.com



 Total Order Amount in US Dollars 

Card holder will pay card issuer above amount pursuant to cardholder agreement  

Signature: __________________________________

We accept most cards including Discover, JCB, Eurocard, Diner's Club, Delta, Switch, Visa, Amex, Mastercard but we charge a 3% surcharge on Diner's Club