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Text File  |  1996-01-14  |  3KB  |  84 lines
  1.  
  2.               ORDER FORM FOR REGISTERED VERSION OF STRETCH BREAK                            
  3.     **********************************************************************
  4.  
  5.     NAME:____________________________________________________________
  6.                                                                 
  7.     COMPANY:_________________________________________________________
  8.                                                                 
  9.     STREET:__________________________________________________________
  10.                                                                 
  11.     CITY:____________________________ STATE:_____ ZIP:_______________
  12.                                                                 
  13.     COUNTRY: _________ TEL: ________________ FAX: ___________________ 
  14.  
  15.     E-MAIL: _________________________
  16.                                                                 
  17.     STRETCH BREAK  US $24.95 x ____  unit(s) =      $__________     
  18.     Shipping & Handling:                                        
  19.       Continental  U.S.             $   4.00                    
  20.       Canada, Mexico                $   6.00                    
  21.       International                 $   8.00                    
  22.       Express USA                   $  20.00        $ _________ 
  23.     Subtotal:                                       $ _________ 
  24.     California residents add 7.75% sales tax        $ _________ 
  25.                                     TOTAL:          $ _________ 
  26.  
  27.                                                                 
  28.     Please send CHECK or MONEY ORDER to:                        
  29.     ***********************************                         
  30.  
  31.                     Para Technologies
  32.                     P.O. Box 1109
  33.                     Costa Mesa, CA  92628-1109
  34.  
  35.                     Tel: 714-546-4607
  36.  
  37.  
  38.  
  39.     For MAIL, FAX, OR E-MAIL orders with MASTER CARD, or VISA:   
  40.     **********************************************************
  41.  
  42.     Fax this form to 714-546-4607, send in this form with the 
  43.     information below, or send an e-mail message with the  
  44.     requested information to  72317.726@compuserve.com
  45.  
  46.  
  47.     Name As It Appears 
  48.     On Credit Card:___________________________________________
  49.  
  50.     MC/VISA # _________________________________________________
  51.  
  52.     MC [ ]  VISA [ ]
  53.  
  54.     Expiration Date ___/___
  55.  
  56.     Signature: ________________________________________________
  57.  
  58.  
  59.  
  60.  
  61.  
  62.  
  63.  
  64.  
  65.  
  66.     
  67.     * Please place TELEPHONE CREDIT CARD orders through: 
  68.     ****************************************************
  69.         
  70.          Public Software Library (PsL)
  71.          Sales: 1-800-242-4775 or 713-524-6394
  72.  
  73.  
  74.     * Stretch Break is listed as product #14382.
  75.  
  76.  
  77.     *** WARNING *** 
  78.  
  79.     The PsL numbers above are exclusively for placing telephone orders 
  80.     with credit cards.  Para Technologies CANNOT be reached at those 
  81.     numbers. If you have questions about the status of your order, volume 
  82.     discounts, etc., please contact Para Technologies directly through 
  83.     their numbers that are listed in prior sections of this form.
  84.