SoftwareSolutions.Net Secure Online Order Form

This form uses Java Script for calculations. If your browser does not support Java Script you can manually fill in the prices and totals. To use this form, enter the quantity of each product desired in the Qty. box and and click the "Click Here to Update Total Before Printing".

Once Printed, fax your order to 303-979-6151

 If you experience any problems, please contact us at support@softwaresolutions.net

Secure Hosting, Vcheck Services Renewals and Custom Programming
Secure Form Setup and Hosting - $55.00
Secure Database and Hosting (Initial)- $120.00
Renewal of Standard Forms Hosting (6 months) - $30.00
Renewal of Database Forms Hosting (12 months) - $60.00
Renewal of Vcheck to PDF System (12 months) - $99.95
Renewal of Vcheck Recurring Payment (12 months) - $49.95
Renewal of Vcheck Multiple Payees (12 months) - $49.95
Renewal of Vcheck Database System (12 months) - $99.95
Custom Programming - each unit equals $1.00

P  A  Y - by - C  H  E  C  K

Please fill in all the mandatory RED fields, exactly as they appear on your check,
and then void your actual check for your records.
You will receive a duplicate of this Virtual Check with your bank's normal
  procedure for statements/canceled checks.
Your Email Address:


  Your Name or Company Name
 
  Second Name, if applicable
 
  Your Street Address
 
  Your City, State, Zip
 
  Your Daytime Phone
  		Bank Name

Bank Branch ( Only if indicated on your check )
Bank Street Address
Bank City, State, Zip
Bank Phone Number

Check Number    
  
Fractional Code    
Example: 44-77/4346 01    
 
DATE: Actual Submission 
Date and Time will be entered, 
Automatically  
 Pay to the order of: SSNet, Inc.    Amount:$
    Pay Exactly Example: Thirty nine dollars and 95/100
 Memo:        Routing #                  Account #
  
Routing and Account Numbers are found at the very bottom of your check.
Sample of Routing #:      Sample of Account #:  
Comments:
   Please enter your initials in this box - your payment CAN NOT be processed
  without them. My Initials in the box authorizes us to use the above
  information to generate a Virtual Check for the Total entered. This authorization is
  for this transaction only.  I understand that I will receive a duplicate of this Virtual
  Check in my bank's normal procedure for statements/canceled checks.


Virtual Check Solutions - Copyright 1997 - 2001 by SoftwareSolutions.Net