SafeShopper Secure Order Form

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SafeShopper

Please read the following information carefully:
Please fill out all fields below to purchase SafeShopper. Pay special attention to your email address as this is where your order information will be sent. If you are concerned about your privacy please take a moment to read our privacy statement here.
SafeShopper is $24.95 US per license + 7% sales tax for North Carolina Residents.

Privacy Statement

It is our policy not to sell or give your contact information to any third parties. In certain cases we must provide customer information to the vendor of the product you are purchasing for your order to be completed.

Enter the number of items you wish to purchase:

Contact Information

Please fill out the information below, as it appears on your credit card, so that we can process your order. Fields marked with * are required to complete your order.

Company Name:
First Name*:
Last Name*:
Licensed To:
Address*:

City*:
State:
ZIP/Postal Code*:
Country*:
Daytime Phone*:
Evening Phone:
VAT ID# (if applicable):

EMail Information

You must use your real email address. Anonymous email services such as hotmail.com, yahoo.com, etc. are subject to extended fraud checking and may delay your order. You may use these addresses in the alternate email field.

Email* (Double check for accuracy!)
Alternate Email

Other Information
How did you hear about us?
Which web site, newspaper or search engine?

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