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Text File  |  1995-01-31  |  2KB  |  56 lines
  1.     
  2.        
  3.        
  4.        
  5.     MoreMem 3.0 Order Form
  6.  
  7.     To:  Gamma Research, Inc.
  8.          112 Teakwood Drive
  9.          Huntsville, AL 35801
  10.             
  11.          (205) 533-7103  (9am-5pm CST) Voice and (24-hour) FAX
  12.     
  13.     From:               
  14.          Name:             ____________________________________________
  15.      
  16.          Company:          ____________________________________________
  17.      
  18.          Street Address:   ____________________________________________
  19.      
  20.                            ____________________________________________
  21.      
  22.          City, State, Zip: ____________________________________________
  23.      
  24.          e-mail Address:   ____________________________________________
  25.      
  26.          Work Phone #:     ____________________________________________
  27.      
  28.          Home Phone #:     ____________________________________________
  29.      
  30.          FAX Phone #:      ____________________________________________
  31.      
  32.     Units:               0-9       10-99      100-999    1000-
  33.     Price/Unit:          $40       $35        $30        $20
  34.   
  35.          Quantity:         ________________
  36.      
  37.          Total:            ________________
  38.      
  39.          Payment Method    ___Visa  ___MC  ___check  ___cash  ___MO  ___PO
  40.      
  41.          Credit Card #     _______   _______   _______   _______
  42.                      
  43.          Expiration Date   _____ / _____
  44.      
  45.          Signature         ____________________________________________
  46.      
  47.     How did you hear about MoreMem ?   ________________________________
  48.  
  49.     Where did you get MoreMem ?        ________________________________
  50.  
  51.     Suggestions:           ____________________________________________
  52.  
  53.                            ____________________________________________
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