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Text File  |  1996-11-10  |  2KB  |  50 lines
  1. ------------------------------------------------------------------
  2.                     KwikDraw Order Form
  3.  
  4.                     The Human Interface
  5.                      902 94th St. S.E.
  6.                     Everett, WA  98208
  7.                       (206) 348-9043
  8. ------------------------------------------------------------------
  9.  
  10.  
  11. Name:    _________________________________________________________
  12.  
  13. Address: _________________________________________________________
  14.  
  15.          _________________________________________________________
  16.  
  17. City:    ________________________ State: _______ Zip: ____________
  18.  
  19. Country: __________________________ Phone: _______________________
  20.  
  21.  
  22. Qty: ______ x $39.95   = $____________            Shipping Rates
  23.                                                 
  24. Shipping (see rates)   = $____________             U.S. & Canada:
  25.                                                   Qty 1-3:   $4.00
  26.                                                   Qty 4-6:   $7.00
  27.                                                   Qty 7-10:  $9.00
  28. C.O.D. fee ($3.00)     = $____________
  29.                                                       overseas:
  30. Total                  = $____________            Qty 1-3:   $7.00
  31.                                                   Qty 4-6:  $12.00
  32.                                                   Qty 7-10: $16.00
  33. please check one:
  34.  
  35. ____ Please ship C.O.D. (U.S. only, $3.00 additional charge)
  36.  
  37. ____ Check enclosed (if you are not from the U.S. or Canada then 
  38.      please use a credit card or international money order 
  39.      in U.S. funds) 
  40.  
  41. ____ Mastercard: __________________________________ Exp: _________
  42.  
  43. ____ Visa: ________________________________________ Exp: _________
  44.  
  45.  
  46.  
  47. Signature: _______________________________________________________
  48.  
  49. please allow 2 weeks for delivery
  50.