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ORDERFRM.DOC
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1991-08-15
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2KB
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60 lines
DATASCOPE(tm) VERSION 1.4x ORDER FORM 026
Name _____________________________ Telephone (____)____-______
Company ______________________________________ Dept. _________
Street Address _________________________________________________
City ___________________________________________________________
State ___________________________ Zip Code __________-________
SHIPPING ADDRESS (if different from above)
Company ______________________________________ Dept. _________
Street Address _________________________________________________
City ___________________________________________________________
State ___________________________ Zip Code __________-________
METHOD OF PAYMENT (check one)
Visa ___ Mastercard ___ Check ___ Money Order ___
Card Number: ______-______-______-______ Expiration: ___/___
Name as it appears on card: ___________________________________
Carholder's Signature: ________________________________________
DATASCOPE OPTIONS (check one of each)
Media: 5.25" ___ Shells: AT ___ Cable: RS-232 ___
3.5" ___ XT ___ AutoMate ___
Registered copy of DataScope Version 1.4.................$189.95
DataScope User's Reference (typeset and bound).............incl.
Two DB-25 or DE-9 connector shells.........................incl.
RS-232 or AutoMate Modulink monitor cable..................incl.
Add $15.00 for AutoMate cable set................$___.__
SUBTOTAL.................................................$___.__
Tax (California residents add 8.25%).................... $___.__
Shipping and Handling (Continental USA)..................$ 7.50
TOTAL....................................................$___.__
REMIT TO: Paladin Software, Inc.
3945 Kenosha Avenue
San Diego, CA 92117