Nota Bene Order Form

Customer Information *Indicates required field Please list information for the person who will be using the program. If you are ordering for someone else, your name can be listed under Payment Information and/or Shipping below.
First and Last Name*
Academic/Student Affiliation (required for special pricing)
Position*
Institution & Department*
I certify that the above information is accurate, and would be willing to provide supporting documentation if required.
Serial Number (if required above)
E-mail address*
Home Phone
Work Phone
Address
Address (second Line)
City, State/Province Zip/Postal	,
Country
Is this a residential or an institutional/business address?

Payment Information If your billing address differs from the address given above, please include it in the "Notes or Further Instructions" section below. *Indicates required field
Name on Card if Different from Above
Credit Card Type*
Credit Card Number*
Expiration Date*

Shipping and Handling New York state and local sales taxes will be added to all orders shipped or downloaded to a New York address. International customers are responsible for any customs, duties or import taxes.
Shipping Mode*
-- Include shipping address if different from address above --
Ship To
Shipping Address
Shipping Address (second Line)
City, State/Province Zip/Postal	,
Country
Is this a residential or an institutional/business address?

Miscellaneous
Notes or Further Instructions
How did you hear about Nota Bene

Thank you for visiting the Nota Bene website.

Click Submit to send your order.
(You should immediately receive e-mail confirmation of any web orders.)

You can also call 800-4NB-ORDER (800-462-6733) or 718-382-1500 to place your order by telephone.

If you prefer, you can print this order form and fax it to 718-382-0003. Please call to confirm that we have received your fax.

If you do not receive confirmation of your order, or if you have any questions about it, please send an e-mail to sales@notabene.com or call 800-462-6733 or 718-382-1500.

Depending on the shipping method selected, and your location, you should receive your program within two to ten business days. All Nota Bene products (except for upgrades) are covered by our 30-day money-back offer (full refund of the purchase price; no refund of the cost of shipping).

We do not share your customer information with any third party.