Product # 11734 WinCharging FAX Order Form ----------------------------------------------------------------- Qty ___ WinCharging Deluxe Edition @ $24.95 each $________ NJ residents please add 6% sales tax $________ Shipping and handling charges -- - in United States $___4.00_ - in Canada $___6.00_ - elsewhere $__12.00_ Shipping and handling $________ Total $________ ----------------------------------------------------------------- Disk size (check one): [ ] 3.5 HD (default) [ ] 5.25 HD ----------------------------------------------------------------- FAX CREDIT CARD ORDERS TO PsL at 713.524.6398 Public (software) Library (PsL) handles all credit card orders for My Little Realm Enterprises. PsL accepts MasterCard, Visa, American Express, or Discover Card. Credit Card ___ Amex ___ Disc ___ MC ___ Visa Credit Card Number____________________________________________ Exp. Date___________ Signature________________________________ ----------------------------------------------------------------- To call in a credit card order, dial 800.242.4775 (if inside the United States) or 713.524.6394. Ask for product # 11734. ----------------------------------------------------------------- Name_______________________________________________________ Company_______________________________________________________ Address_______________________________________________________ City_______________________________________________________ State______________________________________ Zip_____________ Phones: Home________________________ Bus.______________________ EMail Address_________________________________________________ _____________________________________________________R032596SWV20