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Text File  |  1991-07-04  |  2KB  |  59 lines
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  3.  
  4.                                O R D E R   F O R M
  5.                                ===================
  6.  
  7.         Mail To:  S.R. Eddy & Associates   Phone:(Intnl) (+61) 9 455-1004
  8.                   267 Acourt Road
  9.                   CANNING VALE, PERTH
  10.                   WESTERN AUSTRALIA   6155
  11.  
  12.         ____________________________________________________________________
  13.  
  14.         Please tick as appropriate:
  15.  
  16.         Mastercard ____   Visa ____   Bankcard ____ (Australia Only)
  17.  
  18.         Cheque     ____   (Sorry... Aust $, drawn on Australian Banks only.)
  19.  
  20.         Card Number:  _____________________________   Expiry Date:  ________
  21.  
  22.         Name:       ________________________________________________________
  23.  
  24.         Signature:  ________________________________________________________
  25.  
  26.         Company:  __________________________________________________________
  27.  
  28.         Position: __________________________________________________________
  29.  
  30.         Address:  __________________________________________________________
  31.  
  32.         City:  ________________  State:  _______________  Zip/Postcode _____
  33.  
  34.         Country:  _____________________  Phone:  ___________________________
  35.  
  36.  
  37.         DESCRIPTION                                QTY      UNIT       TOTAL    
  38.                                                   PRICE               AMOUNT
  39.         ____________________________________________________________________
  40.  
  41.         Within Australia:
  42.  
  43.              ClipHelp (program and manual on disk) ____ @ Aust$48.00 _______
  44.  
  45.                   (Price includes airmail postage & packing)
  46.  
  47.         Other than Australia:
  48.  
  49.              ClipHelp (program and manual on disk) ____ @   US$48.00 _______
  50.  
  51.                   (Price includes airmail postage & packing)                    
  52.                                                                     ========
  53.  
  54.                                      TOTAL ORDER VALUE (Aust/US)$   ________
  55.  
  56.              Preference: 5.25" (360k) Disk   ____  or 3.5" (720k) Disk  ____
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