PACK MEDIA COMPANY ORDER FORM/FAX FORM
                         Mark items you wish to order 
                                         
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[ ] IN SEARCH OF DR. RIPTIDE - The Ultimate Undersea Adventure
    VGA, Sound Blaster support.........................................$25.00

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"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

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[ ] PACK MEDIA GAME PACK - Dr. Riptide, Elements, Pea Shootin' Pete 
    Save $10 on this gaming madness....................................$65.00

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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!