home *** CD-ROM | disk | FTP | other *** search
/ TopWare 18: Liquid / Image.iso / liquid / top1043 / visaordr.txt < prev    next >
Encoding:
Text File  |  1993-04-06  |  2.3 KB  |  60 lines
  1.     ________________________                 BLUEVIEW SOFTWARE
  2.    |    MagniPaint v3.3     |                2300 Lawrence Ave. East BOX 80551
  3.    |                        |                Scarborough, Ontario
  4.    |------ VISA ORDER ------|                CANADA  M1P 2R0
  5.    |________________________|
  6.  
  7.  
  8. NOTE: ALL information requested below must be that of the card holder.
  9.       VISA orders will processed by "Proven Solutions Inc."  Please
  10.       make a note of this.
  11.  
  12.  
  13. Name (EXACTLY as it appears on the VISA card):
  14.  
  15. ____________________________________________________________________________
  16.  
  17. Address:                                          Apartment/Suite:
  18.         _________________________________________                 __________
  19.  
  20. City/Town:                        State/Province:
  21.           ________________________               ___________________________
  22.  
  23. Zip/Postal Code:                         Country:
  24.                 ________________________         ___________________________
  25.  
  26. Phone Number   : (     )                    Date:
  27.                 ________________________         ___________________________
  28.  
  29.  
  30. VISA Number :                       Expiry Date:
  31.              ______________________             ____________________________
  32.  
  33.  
  34. Bank drawn on :
  35.                _____________________________________________________________
  36.  
  37. Signature :
  38.            _________________________________________________________________
  39.  
  40.  
  41.                                     ---------------------------------------
  42.                                     | Quantity  |    Price    |   Total   |
  43.                                     ---------------------------------------
  44.  
  45.                                                  x $24.00 Cdn =
  46.                                      ___________               ____________
  47.  
  48.                                   Ontario residents add 8% pst
  49.                                                                ____________
  50.  
  51.                                  Canadian residents add 7% gst
  52.                                                                ____________
  53.  
  54.                                                          TOTAL
  55.                                                                ____________
  56.  
  57.  
  58. * PRICE indicated in Canadian funds.
  59.  
  60.