WEB FM ORDER FORM

Please fill in the information below, print the completed form, and mail with your payment.

	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.

Please send this completed form and a Check, Money Order, or Purchase Order made payable to:

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.

11/6/95