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Text File  |  1993-01-04  |  2KB  |  55 lines
  1.                                  Order Form
  2.  
  3.  
  4. Name:     ______________________________________________________________
  5.  
  6.  
  7. Address1: ______________________________________________________________
  8.  
  9.  
  10. Address2: ______________________________________________________________
  11.  
  12.  
  13. City:     __________________________   State:    _______   Zip:_________
  14.  
  15.  
  16. Country/(other codes):  ________________________________________________
  17.  
  18.  
  19. Phone Number:  (________) ________-______________(Hm#/Wk#/FAX)
  20.  
  21.  
  22. Phone Number:  (________) ________-______________(HM#/Wk#/FAX)
  23.  
  24.  
  25. Computer name: ___________________   Printer type:  ____________________
  26.  
  27. Processor: 8086  8088  80186  80188  80286  80386  80386SX
  28.  
  29. -----------------------------------------------------------------------------
  30.  
  31. PC-TRACE                     # Copies_____ @ $85 ea    Total:___________
  32.   Includes Disks, Manual, BBS Pasword
  33.  
  34.  
  35. -----------------------------------------------------------------------------
  36.  
  37.  
  38. Check# ______________
  39.  
  40.  
  41. VISA  or  MC   #___________________________________________
  42.  
  43.  
  44.                                          Expiration date:  _____________
  45.  
  46.                                                    
  47.  
  48.  
  49.                                Douglas E. Ehlers
  50.                           Ehlers Technical Consultants
  51.                                 4520 S. 58th St.
  52.                               Lincoln, NE   68516
  53.                          (402) 435-8440 Voice, evenings
  54.                          (402) 483-1665 BBS 9600,N,8,1
  55.