PACK MEDIA COMPANY ORDER FORM/FAX FORM Mark items you wish to order ----------------------------------------------------------------------------- [ ] IN SEARCH OF DR. RIPTIDE - The Ultimate Undersea Adventure VGA, Sound Blaster support.........................................$25.00 ----------------------------------------------------------------------------- "Boxed" Commercial Software: [ ] ELEMENTS - Puzzle/Logic Game VGA, Sound Blaster support.........................................$29.95 [ ] METAMORF - The Morphing Graphics Utility VGA/SVGA, mouse required...........................................$29.95 [ ] PEA SHOOTIN' PETE - Arcade Fun VGA, Sound Blaster support.........................................$19.95 ----------------------------------------------------------------------------- [ ] PACK MEDIA GAME PACK - Dr. Riptide, Elements, Pea Shootin' Pete Save $10 on this gaming madness....................................$65.00 ----------------------------------------------------------------------------- Information: (please print) Name ________________________________________________________________________ Address (Line 1)_____________________________________________________________ Address (Line 2)_____________________________________________________________ City ___________________________ State _________________ ZIP/Code ___________ Phone/Fax __________________________ SHIPPING CHARGES: $4; Each additional item add $1. ($5 for Game Pack) Total payment: $______________ (FLORIDA residents add 6 percent sales tax.) Payment type: [ ] Visa [ ] MasterCard [ ] Check [ ] Money Order Card number: _________________________________________________________________ Expiration date: _____/_____ (MM/YY) Signature: _____________________________ Mail to: Pack Media Company, Inc. Orders: 1-800-628-3266 P.O. Box 1357 Visa, MasterCard are welcome. Pompano Beach, FL 33061-1357 Or E-Mail a credit card order to us at packmedia@aol.com Make checks payable to "Pack Media Company, Inc." Thank you!