Quantity	Item	Price
	JAVA AdServer Version 2.5	$49.00 each
	Multi-Channel Server-Push Ticker Verson 2.6	$65.00 each
	Multi-Channel Server-Push Ticker UPGRADE to Verson 2.6	$25.00 each

Domain(s) Where Applet will Run (required)
If ordering multiple applets, please indicate clearly which applets are associated with which domains either here or in the additional information box below.

Please fill in your name, address and email.
Name
Company Name
Street Address
City
State and zip code
Country
Email
Phone

Thank you. Your order will be shipped to the above email address as soon as your check is received.

If you prefer to print and mail this form, please include your payment (in U.S. Dollars) and mail to:

KAC Website Design
11999 East Arizona Ave.
Aurora, CO 80012
Email: kenny@kacweb.com