CID-DATA.COM™
2011 Databases
20% Discount Order Form
Prices quoted include the discount!
For credit card orders, fill out and submit the following form. Please use only the "TAB" key to move through fields and not the "RETURN" key!

For check orders, print this form, fill out and mail - do not press "SUBMIT" button.

Your Information

Todays Date:
Your Name:
Company Name:
Address:
City:
State:
 Zip:
Phone:
Ext:
Fax:
E-mail:
Website:
Your Operating System:

Order - Individual State or Special Packages

Select State or Special Package & Cost:

Sub total:
Shipping & Handling (Because of new postal rates)
Add Sales Tax (7.75%) if delivered in California:
Total:

Payment Options:  Credit Card1 or Check2


1. For credit card orders, fill out the following billing information and press the "Submit" button:

Card Type 
Name as it appears on Card: 
Card No:
Exp. Date:
3 or 4-Digit Sec Code (required):
Billing Address:
City:
State:
Zip:

Start over: Press once to send:

2. For check orders, print this form and mail along with your check to:

CID-DATA.COM
PO Box 12584
La Jolla, CA 92039

Please make your checks payable to CID-DATA.COM

For more information, please call (800) 350-8333

© Copyright 2011 CID-DATA.COM™
PO Box 12584 • La Jolla, CA 92039
Ph. 800-350-8333 • Fax. 800-350-8334
info@cid-data.com