Product # 11734 WinCharging 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 ----------------------------------------------------------------- Indicate payment type: [ ] Personal check [ ] Money order Checks and MO's must be drawn on U.S. banks in U.S. funds. Please make payable to My Little Realm Enterprises and mail to: My Little Realm Enterprises 22 Church Street #103, Suite 376 Ramsey, New Jersey 07446 ----------------------------------------------------------------- User Information Name_______________________________________________________ Company_______________________________________________________ Address_______________________________________________________ City_______________________________________________________ State______________________________________ Zip_____________ Home_(_____)_________________ Bus._(_____)_________________ EMail Address_________________________________________________ _____________________________________________________R032396SWV20