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Text File  |  1994-04-10  |  1KB  |  56 lines
  1.                    
  2. [  ] Yes! Send me my copy of NewEntryField 
  3.  
  4. Name:_________________________________________
  5.  
  6. Title:________________________________________
  7.  
  8. Company:______________________________________
  9.  
  10. Address:______________________________________
  11.  
  12. City:_________________________________________
  13.  
  14. State:___________________  Zip:_______________
  15.  
  16. Phone:________________________________________
  17.  
  18. Fax:__________________________________________
  19.  
  20.  
  21.     Calculate the total cost:
  22.  
  23. NewEntryField for OS/2        $78.00    _______
  24.  
  25. NewEntryField for OS/2        $133.00    _______
  26. including Smalltalk/V and
  27. PARTS/V support
  28.  
  29. Shipping and handling        $10.00    _______
  30.  
  31. Taxes
  32.   California residents 8.25%        _______
  33.  
  34.  
  35. Total                    _______    
  36.                  
  37.     
  38.     How you would like to pay:
  39.  
  40. [  ] Check or Money Order (enclosed)
  41.  
  42. [  ] VISA 
  43.  
  44. [  ] MasterCard
  45.  
  46.  
  47. Card Number _____________________________________
  48.  
  49. Expiration Date _________________________________
  50.  
  51. Name on Card ____________________________________
  52.  
  53.  
  54. Signature _______________________________________  
  55.  
  56.