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Screen Saver / Check Orders

Order Form for Check Payment

If you want to pay using a check, please follow the instructions below:

     Instructions: (Read carefully)
  1. Complete sections 1 and 2 of the Order Form and print a copy of the completed form.
  2. Click the "Submit" button at the bottom of the form.
  3. Write a check, drawn on a US bank, for the total amount of your purchase. Make the check payable to Bolivia Web.
  4. Send the check and the printed copy of your order form to our mailing address:

Bolivia Web
5220 Chinley CT.
Charlotte, NC 28226

1. Personal Information


First Name:
Last Name:
State: Zip Code:


2. Product Information

I would like to purchase the following products by Bolivia Web .

Bolivia Views Screen Server

1 License US $9.95

Enter any additional comments here:

Note: Remember to make the check payable to Bolivia Web. As soon as we receive your payment, we will send you a confirmation e-mail with a file containing the screensaver files. Thanks!


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Last Updated 02 February, 2003 - 03:38 PM -0500

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