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Text File  |  1995-12-08  |  2KB  |  58 lines
  1. Complete this form to order additional Edge Interactive Publishing, Inc. disks by mail.
  2.  
  3. Name ____________________________________________________
  4. Address __________________________________________________
  5. City __________________ State __________________  Zip ________
  6. Telephone (optional; helps track order problems)___________________
  7. E-mail________________________________
  8. Computer type and CD-ROM drive speed___________________________
  9.  
  10. I,________________, (print name) certify that I am over 21 years of age.
  11.  
  12. Signature:_________________________________________________
  13.  
  14. __ YES, send me announcements of upcoming Edge Interactive Publishing, Inc. 
  15.      products.  I understand there is no purchase required.
  16.  
  17. __ YES, please send me additional Edge Interactive Publishing, Inc. products.
  18.      I have certified that I am over 21 years of age.
  19.  
  20. Description                                          Quantity       Amount Each    Subtototal
  21.  
  22. Eric Kroll: FETISH                           ________    $49.95     __________
  23.  
  24. Kim Fielding: SHOCK TACTICS            ________    $49.95        __________
  25.  
  26. Pauliina Raitosola: PHO-TOY            ________    $49.95      __________
  27.  
  28. Steve Bonge: TATTOO                           ________    $49.95        __________
  29.  
  30.  
  31. Subtotal................................................................................................_________
  32.  
  33.  
  34. NY Residents add 8.25% sales tax.............................................._________
  35.  
  36. Shipping and handling............................................................................$5.00
  37.  
  38.  
  39. Total........................................................................................................_________
  40.  
  41.  
  42. PAYMENT INFORMATION
  43.  
  44. __ Payment by check or money order made out to:
  45. Edge Interactive Publishing, Inc. is enclosed.
  46.  
  47. __ Please charge my  __ MC  __VISA    
  48.  
  49. Card Number:_________________________________Exp._______
  50.  
  51. Signature_______________________________________________
  52.  
  53. Mail Order Form (and check) to:
  54. Edge Interactive Publishing, Inc.
  55. P.O. Box 20029
  56. Columbus Circle Station
  57. New York, NY 10023-1482
  58.