home *** CD-ROM | disk | FTP | other *** search
/ High Voltage Shareware / high1.zip / high1 / DIR5 / PIXCT27.ZIP / INVOICE.DOC next >
Text File  |  1993-07-07  |  2KB  |  46 lines
  1.                MIDPA Technologies Registration/Order Form
  2. _______________________________________________________________________
  3. Payment must be in U.S. Dollars payable by check or money order drawn
  4. on an American bank, cash, or a postal money order redeemable at any
  5. U.S. Post Office.  Sorry, we can not accept checks drawn from banks
  6. outside the United States.  We also can not accept credit card orders.
  7.  
  8. Make Checks payable to "MIDPA Technologies"
  9.  
  10. and Send to:            MIDPA Technologies
  11.                         P.O. Box 48121
  12.                         Fort Worth, TX  76148
  13. _______________________________________________________________________
  14.  
  15. Your Name:_____________________________________________________________
  16.  
  17. Company:  _____________________________________________________________
  18.  
  19. Address:  _____________________________________________________________
  20.  
  21.           _____________________________________________________________
  22.  
  23.    City:  ________________________________ State: ________
  24.  
  25. Zip Code: _____________
  26.  
  27. Phone:    (______)______-____________
  28. _______________________________________________________________________
  29.                                                       Unit     Total
  30. Quantity:  Product:                                   Price     Cost
  31.  
  32.  
  33. _________  PixCat Version 2.7 Registration (only)   @ $10.00 __________
  34.  
  35. _________  PixCat Registration and 5.25" Disks      @ $20.00 __________
  36.  
  37. _________  PixCat Registration and 3.5" Disks       @ $20.00 __________
  38.  
  39.                                                   Subtotal   __________
  40.  
  41.            Fort Worth Texas residents add  7.75% sales tax,
  42.                 other Texas residents add  7.25% sales tax   __________
  43.  
  44.                                                      Total   __________
  45.  
  46.