Name: ________________________________________________
Email: ________________________________________________
Address: ________________________________________________
________________________________________________
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LICENSE TYPE (tick one)
Single User (US$75) ____ Student (US$35) ____
Twenty User (US$500) ____ Site License (US$750) ____
FORM OF PAYMENT (tick one)
___ Cheque or Money Order (made out to UniQuest Limited)
___ Invoice
___ Visa
___ Mastercard
___ BankCard
CREDIT CARD DETAILS
Full name on card ____________________________
Card # ____________________________
Expiration Date _____
Please debit my credit card for US$_______________
Signature _________________________________________
INVOICE ADDRESS
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Send completed order form with enclosed payment to:
postal mail:
BrainWave (c/o Dr. Devin McAuley)
School of Psychology
University of Queensland
Brisbane, Queensland 4072 Australia
General enquiries can be directed to: brainwav@psy.uq.edu.au
