R.S. Digital Solutions Stony Plain, Alberta, Canada

 
MEDIBILL^TM
REGISTRATION FORM v5.33

Please answer the registration questionnaire below and return this form with your cash, check or money order to:
 

R.S. Digital Solutions
5708 - 47th Street
Stony Plain, Alberta   T7Z 1C6
Canada
 
 

Name    ________________________________________________________________

Address ________________________________________________________________

        ________________________________________________________________

        ________________________________________________________________

        ________________________________________________________________

Phone (_______)_______-____________    Fax (_______)_______-____________

E-mail  ________________________________________________________________




MEDIBILL Registration .................................... $ 400.00
(Includes latest version of program, printed
documentation and upgrade notices.)

Shipping & Handling ...................................... $  10.00
                                                           ========

Sub-Total ................................................ $ 410.00
GST (5% of Sub-Total) .................................... $  20.50
                                                           ========

Total Enclosed ........................................... $ 430.50

(Thank you for choosing MediBill^TM)