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Text File  |  1993-09-26  |  3KB  |  55 lines
  1.                                  ORDER FORM
  2.  
  3.  For credit card or multiple                     For cash or cheque orders
  4.  product orders send to                          for DAUB only send to
  5.  
  6.  ARK ANGLES                                      TOPLINE SOFTWARE
  7.  24 Alexander Ave                                P O Box 66
  8.  Hazelbrook  NSW  2779                           Rundle Mall  SA  5000
  9.  AUSTRALIA                                       AUSTRALIA
  10.  Phone: (047) 588100 or Intl+61-47-588100
  11.  Fax:   (047) 588638 or Intl+61-47-588638
  12.  
  13.  From: Name    ______________________________________________________________
  14.  
  15.        Company ______________________________________________________________
  16.  
  17.        Address ______________________________________________________________
  18.  
  19.        Town    _____________________________  State _________  Code _________
  20.  
  21.        Country ______________________________________________________________
  22.  
  23.        Phone   _____________________________  Fax ___________________________
  24.  
  25.  Where did you obtain the program(s)? _______________________________________
  26.  
  27.  Computer:   [ ] XT   [ ] AT/286   [ ] 386SX   [ ] 386DX   [ ] 486   [ ] >486
  28.  Memory Size: ____________   Hard Disk Size: __________
  29.  Floppies:   [ ] 5.25" 360K   [ ] 5.25" 1.2M   [ ] 3.5" 720K   [ ] 3.5" 1.44M
  30.  Screen:    [ ] Mono    [ ] Herc    [ ] CGA    [ ] EGA    [ ] VGA    [ ] >VGA
  31.  Dos Version: ________   Windows Version: _________   OS/2 Version: _________
  32.   _____________________________________________________ ________ ___________
  33.  | P R O D U C T  /  L I C E N S E                     | Q T Y  | P R I C E |
  34.  |_____________________________________________________|________|___________|
  35.  |                                                     |        |           |
  36.  |_____________________________________________________|________|___________|
  37.  |                                                     |        |           |
  38.  |_____________________________________________________|________|___________|
  39.  |                                                     |        |           |
  40.  |_____________________________________________________|________|___________|
  41.  |                                                     |        |           |
  42.  |_____________________________________________________|________|___________|
  43.  | Shipping                                                     |     $5.00 |
  44.  |______________________________________________________________|___________|
  45.  | T O T A L                                                    |           |
  46.  |______________________________________________________________|___________|
  47.  
  48.  [ ] Bankcard   [ ] Mastercard   [ ] Visa   [ ] Cash/Cheque/Draft/Money Order
  49.  
  50.  Credit Card Number _______ _______ _______ _______   Expiry Date ____ / ____
  51.  
  52.  Cardholders Name   _________________________________________________________
  53.  
  54.  Signature          _______________________________   Date __________________
  55.