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Text File  |  1996-01-22  |  3KB  |  62 lines
  1. ORDER FORM
  2.  
  3. SYNTEGRATION
  4. 3811 Schaefer Avenue #J, Chino, California 91710, U.S.A.
  5. Tel: 1-909-464-9450  Fax: 1-909-627-3541
  6.  
  7. BILLING NAME AND ADDRESS:              SHIPPING NAME AND ADDRESS:
  8. --------------------------             --------------------------
  9.  
  10. __________________________________     ______________________________________
  11.  
  12. __________________________________     ______________________________________
  13.  
  14. __________________________________     ______________________________________
  15.  
  16. __________________________________     ______________________________________
  17.  
  18. __________________________________     ______________________________________
  19.  
  20. Tel:______________________________     Fax:__________________________________
  21.  
  22. SALES TAX
  23. California residents add 7.75% of subtotal for sales tax
  24.  
  25. PAYMENT METHOD                         SHIPPING FEE
  26.  
  27. ___ Check or Money Order enclosed      ___ $8  Standard service in the US
  28.                                        ___ $10 Standard service to Canada
  29. Credit Card:                           ___ $15 2 Day service in the US
  30. ___ VISA                               ___ $21 Overnight service in The US
  31. ___ Mastercard                         ___ $30 Express Service to Canada
  32. ___ Discover                           ___ $60 Express Service Worldwide
  33.  
  34. Card Number:______________________     Expiration Date:_____________________
  35. Cardholder
  36. Name:_____________________________     Signature:____________________________
  37.  
  38. Quantity   Description                              Unit Price         Amount
  39. --------   --------------------------------------   ----------  -------------
  40.  
  41. ________   Traveling Workplace for OS/2                 $59.95  _____________
  42.  
  43. ________   The Secure Workplace for OS/2                $79.95  _____________
  44.            Standard Edition
  45.  
  46. ________   The Secure Workplace for OS/2               $700.00  _____________
  47.            Enterprise Edition
  48.            (includes a 10 station site license)
  49.  
  50. ________   The Secure Workplace Upgrade                 $25.00  _____________
  51.            (registered users only)
  52.  
  53. ________   The Secure Workplace for OS/2                $74.00  _____________
  54.            Additional Licenses
  55.                                                       SUBTOTAL  _____________
  56.  
  57.                                                      SALES TAX  _____________
  58.  
  59.                                                       SHIPPING  _____________
  60.  
  61.                                                          TOTAL  _____________
  62.