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ORDER.FRM
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1994-04-03
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3KB
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48 lines
ORDER FORM
Name: ______________________________________________________________
Address: ___________________________________________________________
City: _____________________ State: ________ ZIP: _________________
Country (if outside US): ___________________________________________
Phone Number (optional): _____________ Circle: home or work
Shareware Version of Program evaluated (optional): _________________
Where you found Sharewave Version (optional): ______________________
Product Quantity Price Each Total
===================================================================
PMJPEG for OS/2 2.x ____ $20.00 U.S. _____
WinJPEG for Windows 3.x ____ $25.00 U.S. _____
WinJPEG Update Fee (from any registered version of WinJPEG)
____ $5.00 U.S. _____
===================================================================
Merchandise Total: ______
5% Sales Tax (Massachusetts residents only): ______
Shipping and Handling (choose one): ______
__ E-mail (no additional charge)
__ U.S. residents ($4 U.S.)
__ Non-U.S. residents ($8 U.S.)
Subtotal: ______
For Visa/MasterCard Orders, add 10% of Subtotal: ______
TOTAL: ______
(Non-credit card order payments must be in U.S. cash,
U.S. funds drawn on a U.S. bank, or a postal money order)
Please fill in the following for Credit Card Orders:
Signature: _______________________
Name on Card: ____________________ Visa [ ] MasterCard [ ]
Credit Card Number: ___________________ Expiration Date: _______
Choose Disk Size (check one if you did not select "E-mail" for shipping):
__ 5 1/4" DS/DD (360K) disk
__ 3 1/2" DS/HD (1.44 MB) disk
E-mail Address (optional except E-mail Shipping): _________________
Circle Type of Email Address: Internet Compuserve AOL Delphi
Mail to: Internet Address:
Norman Yee nyee@osiris.ee.tufts.edu
58 Chandler St. kenyee@ksr.com
Boston, MA 02116
U.S.A.