Assort 
Version 4.0 
Order Form 
For more information on the ASSORT program,
visit our Web site at www.assort.com
Purchase of the ASSORT program entitles all ophthalmologists in the practice to use the program. Special networking requirements may entail additional costs.
1999 prices:
ASSORT version 4.0: U.S.$4,900
VECTrAK: U.S.$595 standard version; $895 or $1,595 for upgrades
 
Your name: ______________________   Institution/Company: _____________________

Address: _______________________________________________________________
 
                _______________________________________________________________

City: ___________________   State/Province: ____________  Postal code: __________

Country: ________________  Phone: _________________  Fax: __________________
 
Program
OS (choose one)
Media (choose one)
Quantity
Price
ASSORT Version 4.0 __ Windows 3.11 

__ Windows 95/NT

 __ Diskettes 

__ CD-ROM

 ______ x 
$4,900 ea
VECTrAK __ Windows 3.11 

__ Windows 95/NT

 __ Diskettes 

__ CD-ROM

 ______ x 
$595, $895, $1,595 ea

                                                                                                            Total amount due: ___________
Payment to be made by (choose one):

            ___ Check (payable to ASSORT Pty. Ltd.)
            ___ Credit card (complete credit card information below)

                        Type of card:                                         Card number: _________________________

                            ___ MasterCard                                       Signature: ___________________________
                            ___ Visa
                            ___ Bankcard                                    Exp. date (M/D/Y): _____ / _____ / _____
 

Please fax this completed form to ASSORT Pty. Ltd. at fax number 61 3 9585 0995
If you wish to pay by check, please fax a copy of the check to the above fax number,
together with this completed form, and send the original check and this form by mail to:
ASSORT Pty. Ltd., 7 Chesterville Road, Cheltenham, Victoria 3192, Australia
For customer service, call 61 3 9584 6966; or toll free from U.S., 800-345-1632