Legacy Press - Purchase

Practice Today Order Form

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Please PRINT THIS PAGE. Then, complete the form and mail (or fax) to:

Practice Today
Mail Order Dept.
PO Box 881705
Los Angeles, CA 90009

Phone (888) 881-0038
FAX: (626) 578-9524

Your software will be shipped within two business days. Please allow five days for personal checks to clear.

A red star (*) indicates required information.

*Name:

*Name of Practice:

*Type of Practice:

*Mailing Address:

*Phone Number (include area code):

Fax Number (include area code):

*E-Mail:

*Product(s):

(Check appropriate items)

	Product	Price
	Practice Today (Pro)	$7945.00 (single user) $8560.00 (5-user) $8995.00 (10-user) $3650.00 (single user, zero support)
	Practice Today (Student) Intern, Resident, Medical Student	$189.00
	Practice Today (Rx)	Free
	Practice Today (Rx) Intern, Resident, Medical Student	$149.00
	Practice Today (Basic)	$695.00
	Practice Today (Basic) Intern, Resident, Medical Student	$189.00
	C4 Made Easy	$395.00
	Annual Support Contract	$4200.00
	12 Support Coupons	$1500.00
	1 Support Coupon	$150.00
	Training Seminar Enter Location for Training Seminar:	$150 per person, or $1250 on-site per day, or $300 per hour on-line
	Shipping and Handling (Required)	$5.00
	Special Promotion	$
	Total Amount Enclosed:

Payment Method:

Comments or Special Requests: