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Text File  |  1995-05-10  |  2KB  |  58 lines
  1.        
  2.  
  3.     MoreMem 4.0a Order Form
  4.  
  5.     To:  Gamma Research, Inc.
  6.          112 Teakwood Drive
  7.          Huntsville, AL 35801-3453
  8.             
  9.          (205) 533-7103  Sales (9am-5pm CST) Voice and (24-hour) FAX
  10.          (205) 881-5341  Tech Support (9am-5pm CST)
  11.          gamma@traveller.com  Internet e-mail
  12.          NOTE:  DO NOT SEND CREDIT CARD NUMBERS BY INTERNET E-MAIL.
  13.          CREDIT CARD NUMBERS SHOULD BE SENT BY FAX, MAIL, OR PHONE.
  14.  
  15.     From:               
  16.          Name:             ____________________________________________
  17.      
  18.          Company:          ____________________________________________
  19.      
  20.          Street Address:   ____________________________________________
  21.      
  22.                            ____________________________________________
  23.      
  24.          City, State, Zip: ____________________________________________
  25.      
  26.          Phone #:          ____________________________________________
  27.      
  28.          FAX Phone #:      ____________________________________________
  29.      
  30.          e-mail Address:   ____________________________________________
  31.      
  32.     Units:               1-9       10-99      100-499    500-       1000-
  33.     Price/Unit:          $40       $35        $30        $20        Call    
  34.   
  35.          Quantity:         ________________
  36.                                                $0 to Mail Password
  37.          Shipping:         ________________    $5 per Disk ___3.5" ___5.25"
  38.                                               $15 for Overnight Disk
  39.          Total:            ________________
  40.      
  41.          Payment Method    ___Visa ___MC ___Amex ___Check ___Cash ___MO ___PO
  42.      
  43.          Credit Card #     _______   _______   _______   _______
  44.                      
  45.          Expiration Date   _____ / _____
  46.      
  47.          Signature         ____________________________________________
  48.      
  49.     How did you hear about MoreMem ?   ________________________________
  50.  
  51.     Where did you get MoreMem ?        ________________________________
  52.  
  53.     Suggestions:           ____________________________________________
  54.  
  55.                            ____________________________________________
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