Please read the following information carefully: By completing this online order form you are authorizing BMT Micro, Inc. to charge your credit card in the amount shown. This process is automated and you will be informed by email on how to license your copy of the software. We also receive electronic copies of all server activity. If you are concerned about your privacy please take a moment to read our privacy statement here. Thank you for placing an order with BMT Micro, your software resource. You will receive an acknowledgement of your order via email as soon as the order is submitted. Please email us at orders@bmtmicro.com if you have any questions regarding your order. Please fill out all fields below to purchase AppMentor. Pay special attention to your email address as this is where registration will be sent. Sophax is $12.99 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 licenses 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 in Yellow are required to complete your order. Company Name: First Name: Last Name: Licensed To: Address: City: State/Province: (US and Canada) Outside US & Canada Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington West Virginia Wisconsin Wyoming ********************************* Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory ********************************* Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific ZIP/Postal Code: Country: Please Select Country   United States (US) United Kingdom (UK) Germany Australia Canada   Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Balearic Islands Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Ceuta Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Republic of Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Melilla Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (France) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Tahiti Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay US Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wake Island Wallis and Futuna Islands Yemen Zambia Zimbabwe Daytime Phone: Evening Phone:

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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.
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Credit Card Expiration Date:	01 02 03 04 05 06 07 08 09 10 11 12 / 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

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About Credit Card Fraud

By submitting this order you are stating that you are the cardholder of the credit card and that the charge is authorized. We take credit card fraud seriously and report all instances of abuse to legal authorities and to the card issuer. Do not press this button more than once. If you encounter problems, please contact us at orders@bmtmicro.com or 800-414-4268 / 910-792-9100.