CG ORDER1

Please complete the Order Form for Cybergenie Handset Firmware Upgrades below. All Fields marked with* must be filled out. This Form is for Credit Card and PayPal Payments ONLY and will accept, Visa, MasterCard, American Express and Discovery Cards.

First Name	*
Last Name	*
Company	*
Address	*
City	*
State/ Providence	*	Zip*
Country	*
Telephone #
Email Address	*


Services
No of Handsets	*	x $15.00 per handset
Amount Due		+ shipping and handling