home *** CD-ROM | disk | FTP | other *** search
/ Software Vault: The Diamond Collection / The Diamond Collection (Software Vault)(Digital Impact).ISO / cdr29 / planet22.zip / ORDER.FRM < prev    next >
Text File  |  1995-02-26  |  2KB  |  39 lines
  1.                                 ORDER FORM
  2.                                 ==========
  3.  
  4.     Name ______________________________________________________________
  5.     Company(if applicable) ____________________________________________
  6.     Address ___________________________________________________________
  7.     City/Province ____________________ State _________ Zip ____________
  8.     Country (if outside US) ___________________________________________
  9.     Phone Number (optional) __________________
  10.     FAX Number   (optional) __________________
  11.  
  12.     Internet Address __________________________________________________
  13.  
  14.     Place Where You Found Program _____________________________________
  15.  
  16.     Additional Comments/Suggestions: __________________________________
  17.     ___________________________________________________________________
  18.     ___________________________________________________________________
  19.     ___________________________________________________________________
  20.  
  21.     ┌────┬────────────────────────────────────┬───────┬────────────┐
  22.     │Qty.│Product                             │ Price │Qty. x Price│
  23.     ├────┼────────────────────────────────────┼───────┼────────────┤
  24.     │____│Planets                             │ FREE  │    FREE    │
  25.     │____│NoteMan/2                           │$10.00 │$________.00│
  26.     │____│QuoteMan/2                          │$10.00 │$________.00│
  27.     │____│BMPMan/2                            │$ 5.00 │$________.00│
  28.     │____│Hangman                             │$10.00 │$________.00│
  29.     │____│Other: ____________________________ │$10.00 │$________.00│
  30.     └────┴──────────────────────────────┬─────┴───────┼────────────┤
  31.     (Payment must be in U.S. funds)     │ Grand Total │$________.00│
  32.                                         └─────────────┴────────────┘
  33.  
  34.     Mail to:  Everett Barnes
  35.               2430 Erie Drive
  36.               Concord, CA 94519
  37.  
  38.                         === I appreciate your support! ===
  39.