========================  TurboDLD Deluxe Order Form  =======================
     
     Panacea, Inc. -  24 Orchard View Drive  -  Londonderry, NH 03053-3351 
	 Voice: 800-729-7420,   Fax: 603-434-2461,  BBS: 603-432-5193              
_____________________________________________________________________________

TurboDLD Deluxe can be purchased through your local Panacea Authorized
Reseller or directly from Panacea. For the Reseller nearest you or to place
a phone order, call our Sales Department at 800-729-7420.

To fax or mail your order, print out this document, fill in the necessary 
information and fax it to (603) 434-2461, or mail it to the address above.
_____________________________________________________________________________
Customer Information:
     
	      Name: __________________________________________________
	     
	   Company: __________________________________________________

	   Address: __________________________________________________                          
	  
	      City: _______________________  State:___________________

	       ZIP: _______________________  Country: ________________
	   
   Daytime Phone #: ____________________   FAX #: ____________________

=============================================================================

   TurboDLD Deluxe  $249.00 each  x ______ =  ______

	     Shipping (per chart) x ______ =  ______
					   
   ORDER TOTAL (U.S. Funds)                $________  

    Save up to 60%  -  Call for 5 and 10 pack pricing. 

TERMS:  MasterCard, VISA, American Express, Check or Money Order drawn on 
	a U.S. bank in U.S funds accepted.  Please make checks payable to 
	PANACEA, Inc. Prices and terms subject to change without notice.

=============================================================================
Shipping Chart:
		 Continental U.S.   Alaska & Hawaii   Canada    Europe
      
      Normal         $ 9.00              N/A          $29.00   $41.00
		    (2 days)                         (3 days)  (5 days)      
    
    Overnight        $13.00            $23.00           N/A      N/A
	       (Guaranteed next day - order must be received by 1PM EST)               
_____________________________________________________________________________
Credit Card Information:

     Card Type (circle one):   MasterCard   VISA   American Express 
 
  Card Number _____________________________  Expires: ____________________

  Card Holder's Name (As printed on card) ________________________________

  Card Holder's Signature REQUIRED _______________________________________