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Secure On-Line Order Form
(Highlight red text for explanatory notes, items marked with Mandatory Field (must not be left blank) are mandatory)

Mandatory Field (must not be left blank) Contact Name 

Position 

Mandatory Field (must not be left blank) Company NameCompany Name - This is the name which will appear in the license file 

Mandatory Field (must not be left blank) Address 

   
   
   

Mandatory Field (must not be left blank) Country 

Country Code             Area Code            Number

Telephone Number 

                        

Fax Number 

                        

Mandatory Field (must not be left blank) Email AddressEmail Address - The accuracy of your email address is extremely important as your license file will be sent to you via email. 

 Product  EazyEFT Annual Charge - (excluding taxes if applicable)

Mandatory Field (must not be left blank) Charge AreaAll Irish customers are subject to Value Added Tax at current rates. E.U. customers who do not supply a valid tax number will also be subject to Value Added Tax at current Irish rates. All others are exempt. 

Ireland    EU    Outside the EU

Tax NumberEU customers please note that when entering your tax number you must also enter your country code e.g. IE 1234567A 

Coupon Code (if any)If you were given a coupon code please enter it here. 

Mandatory Field (must not be left blank) Payment MethodPayment for all orders MUST be made in Euro. Cheques and bank drafts should be made payable to Lir Software Ltd. and crossed "A/C Payee Only. Not Negotiable". If paying via EFT (electronic fund transfer) please specify that all fees are to be paid by you. 

VISA
American Express
Access/MasterCard/EuroCard
Cheque/EFT/Bank Draft

 Card Number 

 Card Expiry Date 

Card Check Digit/Batch Code 

 Card Holders Name 

 Card Holders Address 
   
   
   
   

Special Requirements 

 
Check that the order details above are correct before proceeding.
 

                     
 

 

 

 

 
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