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Text File  |  1995-12-20  |  1KB  |  33 lines
  1. IB&C v2.0 Fax Order Form
  2.  
  3. PURCHASE ORDER#___________________________________________________
  4. COMPANY___________________________________________________________
  5. NAME______________________________________________________________
  6. TITLE______________________________________________________________
  7. ADDRESS____________________________________________________________
  8. CITY_________________________________   STATE__________  ZIP__________
  9. COUNTRY___________________________________________________________
  10. PHONE#______________________  FAX#_________________________________
  11. Where did you hear of us?______________________________________________
  12.  
  13. MAC_____            Windows_____
  14.  
  15. Send _______CD-ROM's @ $180 each        ----> TOTAL $_________________
  16. Shipping & Handling:                                                    _________$7.00 S&H (Domestic)
  17.                                                                                    _________$20.00 S&H(International)
  18.  
  19.                                                                                                                                             TOTAL ___________
  20.  
  21. CHECK#_______________________________
  22.  
  23. or
  24.  
  25. Visa____        Mastercard____        AMX____
  26. Credit Card #__________________________________________________
  27. Name on Card______________________________   Exp Date____________
  28.  
  29.  
  30.  
  31. s t a t (tm) m e d i a    7077 East Shorecrest Drive,        Anaheim Hills,       CA      92807
  32. Voice 714 Ñ 280 Ñ 0038         stat¬media@eworld.com             FAX 714 Ñ 748 Ñ 0178
  33.