home *** CD-ROM | disk | FTP | other *** search
/ Media Share 9 / MEDIASHARE_09.ISO / private / cprbrv21.zip / INVOICE.DOC < prev    next >
Text File  |  1980-01-01  |  2KB  |  56 lines
  1. PC-DSD /Order Form
  2.  
  3. Remit To:
  4. Public Software Library
  5. P.O Box 35705
  6. Houston,Tx 77235-5705
  7.  
  8. Phone Orders to: 1-800-242-4775
  9.  
  10. Date:______________________
  11.  
  12. From:
  13. Name:__________________________________
  14. Add1:__________________________________
  15. Add2:__________________________________
  16. City:__________________________________  St:___  Zip:____________
  17. Phone:_____________________
  18.  
  19. Qty                                                      Unit $    Total $
  20.  
  21. ______  Rollcall.DBMS...(8/92).....................(R)   $69.95  $ _______
  22.  
  23. ______  PCMDS OBRA SOFTWARE...(August 92)..........(R)  $275.00  $ _______
  24.  
  25. ______  Quality Management System (8/92)...........(R)  $175.00  $ _______
  26.  
  27. ______  LVN2 MEDICAL/SURGICAL REVIEW...(8/92)......(R)  $ 30.00  $ _______
  28.         (CEU'S CREDIT AVAILABLE)
  29.  
  30. ------  LVN MEDICAL/SURGICAL REVIEW ..........8/91.(R)  # 22.50  $ _______
  31.  
  32. ------  CNA NURSE ASSISTANT REVIEW PROGRAM..(8/92).(R)  $ 22.50  $ _______
  33.  
  34. ------  CPR BYSTANDER REVIEW PROGRAM....(8/92).....(R)  $ 22.50  $ _______
  35.  
  36. ------  FYI2 - THE BOSS PERSONAL RECORD KEEPER.....(R)  $ 59.50  $ _______
  37.              (FOR YOUR EYES ONLY)   8/92
  38.  
  39. ------  Distribution License .........................  $ 99.00  $ _______
  40.             (Call author for details)
  41.  
  42. Shipping   US Canada  Add $ 4.00                                 $ _______
  43.            Overseas   Add $20.00
  44. Taxes      Add 6.75%                                             $ _______
  45.  
  46.                                                         Total    $ _______
  47.  
  48.  
  49. Diskette Size: [ ] 5.25 inch  [ ] 3.5 inch
  50.  
  51. Visa/MC/PO#:_____________________________  Exp date:___/___
  52.  
  53. Signature:_________________________________________________
  54.  
  55. Thank you for your order!
  56.