home *** CD-ROM | disk | FTP | other *** search
/ OS/2 Shareware BBS: InfoMgt / InfoMgt.zip / marb91c.zip / ORDER.FRM < prev    next >
Text File  |  1996-03-11  |  3KB  |  63 lines
  1.                               ORDER FORM
  2.  
  3.  Name: ______________________________________________________________
  4.  Organization: ______________________________________________________
  5.  Department: ________________________________________________________
  6.  Mail Stop/Suite: ___________________________________________________
  7.  Address: ___________________________________________________________
  8.  City: _____________________  State: ________  ZIP: _________________
  9.  Country (if outside US): ___________________________________________
  10.  Phone Number: _____________  Circle:  home  or  work
  11.  Fax Number: _______________  E-mail: _______________________________
  12.  Shareware Version of Program evaluated (optional): _________________
  13.  Where you found Shareware Version (optional): ______________________
  14.  
  15.   Product                       Quantity     Price Each         Total
  16.   ===================================================================
  17.   Moneta Arbor for OS/2 2.x (and later)
  18.    (Valid through April 15, 1996,
  19.     Includes Version 1.0        ) ____       $50.00 U.S.        _____
  20.   Moneta Arbor for OS/2 2.x (and later)
  21.    (April 16, 1996 and beyond   ) ____      $100.00 U.S.        _____
  22.   Unlimited Updates for One (1)
  23.    Calendar Year                  ____       $25.00 U.S.        _____
  24.  
  25.     [Please contact The Number Company for quantities of ten (10) 
  26.      or more: moneta@thenumberco.com]
  27.  
  28.   ===================================================================
  29.                                             Merchandise Total: ______
  30.  
  31.                            4.5% Sales Tax  (Must Be Included): ______
  32.                            Shipping and Handling (choose one): ______
  33.                             __  E-mail (no additional charge)
  34.                             __  Download @ www.thenumberco.com 
  35.                                     (no additional charge)
  36.                                                      Subtotal: ______
  37.                                                         TOTAL: ______
  38.  
  39.        [Note: E-mail delivery requires the use of a mail
  40.               program supporting MIME. No other E-mail
  41.               option is available.]
  42.  
  43.    (Non-credit card order payments must be in U.S. cash,
  44.     U.S. funds drawn on a U.S. bank, or a postal money order)
  45.  
  46.   Please fill in the following for Credit Card Orders:
  47.       AmEx [ ]   Discover [ ]
  48.       Signature: _____________________________________________________
  49.       Name on Card: __________________________________________________
  50.       Credit Card Number: ____________________________________________   
  51.       Expiration Date: _____________________
  52.  
  53.  
  54.  Mail to:                        Internet Address:
  55.          The Number Co, Inc                     moneta@thenumberco.com
  56.          Suite 101                              www.thenumberco.com
  57.          12007 Bobwhite Drive
  58.          Catharpin, VA 22018-1322
  59.          USA
  60.  
  61.  Fax:
  62.          703.754.9500
  63.