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Text File  |  1991-08-15  |  2KB  |  59 lines
  1.  
  2.                     DATASCOPE(tm) VERSION 1.4x ORDER FORM            140
  3.  
  4.  
  5.         Name _____________________________   Telephone (____)____-______
  6.  
  7.         Company ______________________________________   Dept. _________
  8.  
  9.         Street Address _________________________________________________
  10.  
  11.         City ___________________________________________________________
  12.  
  13.         State ___________________________   Zip Code __________-________
  14.  
  15.  
  16.                    SHIPPING ADDRESS (if different from above)
  17.  
  18.         Company ______________________________________   Dept. _________
  19.  
  20.         Street Address _________________________________________________
  21.  
  22.         City ___________________________________________________________
  23.  
  24.         State ___________________________   Zip Code __________-________
  25.  
  26.  
  27.                          METHOD OF PAYMENT (check one)
  28.  
  29.         Visa ___      Mastercard ___      Check ___      Money Order ___
  30.  
  31.         Card Number:  ______-______-______-______   Expiration:  ___/___
  32.  
  33.         Name as it appears on card:  ___________________________________
  34.  
  35.         Carholder's Signature:  ________________________________________
  36.  
  37.  
  38.                      DATASCOPE OPTIONS (check one of each)
  39.  
  40.         Media:  5.25" ___       Shells:  AT ___       Cable:  RS-232 ___
  41.  
  42.                  3.5" ___                XT ___             AutoMate ___
  43.  
  44.  
  45.         Registered copy of DataScope Version 1.4.................$189.95
  46.         DataScope User's Reference (typeset and bound).............incl.
  47.         Two DB-25 or DE-9 connector shells.........................incl.
  48.         RS-232 or AutoMate Modulink monitor cable..................incl.
  49.                 Add $15.00 for AutoMate cable set................$___.__
  50.         SUBTOTAL.................................................$___.__
  51.         Tax (California residents add 8.25%).................... $___.__
  52.         Shipping and Handling (Continental USA)..................$  7.50
  53.  
  54.         TOTAL....................................................$___.__
  55.  
  56.  
  57.                   REMIT TO:  Paladin Software, Inc.
  58.                              3945 Kenosha Avenue
  59.                              San Diego, CA  92117