Purchase Order Form

Instructions:
To mail or fax in your order print out the form below, then fill out the form. Include your check, or credit card information and mail or fax to Royalty Management Services. You may call in your order at any time and your payment information will be taken over the phone.  A Registration Number will be assigned to you after purchase.

Royalty Management Services, Inc.
P.O. Box 53385
Lafayette, LA 70505
Item Description Price Quantity Total Price

Royalty Management Program 
including 30-day free technical support

$995

   

FREE 30 Day Trial version of Royalty Management Program with Overview and Tutorial

FREE

   

Sub-total:        

 

Sales Tax (LA only)*:        

 

TOTAL:        

 

*Sales Tax:  Louisiana Residents add 4% state sales tax

Ship To: ____________________________________________________________

                ____________________________________________________________

                ____________________________________________________________

                ____________________________________________________________

Contact:  __________________________     Phone #:  ________________________

Email:  ____________________________     Fax #:  __________________________

Payment Type:       (    ) Check     (    ) Discover     (    ) Master Card     (    ) Visa     (    ) American Express               

Card #:  ______________________________________     Exp. Date:  ___________

Name on Card: ______________________________________________________

 

Signature: __________________________________________________________

SALES:  1-800-696-0588 | TECHNICAL SUPPORT:  (337) 235-0856 | FAX:  (337) 235-7062 | E-MAIL: rmp@oilbusiness.com