WEB FM ORDER FORM


Please fill in the information below and SUBMIT your order.
	First Name:        
Last Name:
Company:
Address:

City:
State/Province:
ZIP/Postal Code:
Country:
Phone:
Email (Technical):
Email (Business):

Web Server Domain Name or IP Address (if known):

Web Server CPU?


As of November 6th, 1995, pricing for WEB FM is $195.

Number of WEB FM licenses: x $ = $ Total.

Credit Card: VISA MasterCard American Express

Card Number: Expires:

Distribution: Download Email


Web Broadcasting Co. (WBC)
555 Bryant St. #386
Palo Alto, CA 94301
(415)329-9676

All orders will be confirmed with a receipt via Email and US Mail.
Check the WEB FM Home Station for additional methods of payment as they become available.


10/23/95