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Product Order Form

From: 	                                                                                                                                    	Date:

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To: 	

True BASIC Inc.
12 Commerce Avenue, Suite 3, West Lebanon NH 03784-1669
24-Hr. Fax: 603 298-7015   •  800 436-2111  •  e-mail: sales@truebasic.com

	Order:	

	____	 QwikRAFFLE™ for Macintosh.   	Item #: 79-008&Q.	    @ 29.00 each :          _______

	____	 #76-011 Perfed paper for raffle tickets.  100-sheet pack	  @ 6.00 each :     _______


	____	 #76-012 Perfed paper for raffle tickets.  500-sheet pack	  @ 24.00 each :  _______


	____	 #76-3x10 Labels.   50-sheet pack (1500 labels).	    @ 8.95 each :                    _______

	____	 #76-3x10 Labels.   250-sheet pack (7500 labels).	    @ 35.95 each :              _______

	____	 #76-2x5 Labels.   50-sheet pack (1500 labels).	    @ 8.95 each :                      	_______

	____	 #76-2x5 Labels.   250-sheet pack (7500 labels).	    @ 35.95 each :                	_______

	____	 ZipZAPP™ for Macintosh.   	Item #: 53-MAC&Q.	    @ 29.00 each :                 	_______

	____	 QwikCONGRESS™ for Macintosh.   	Item #: 79-015&Q.@ 19.00 each :     	_______

                                                                                                                                                       Shipping:	           $5.00

	                                                                                                                                     Total Enclosed:	   $   _______

Payment by: 

 [   ] Cash, check or money order;    [   ] Visa;    [   ] MasterCard;   [   ] Discover;   [   ] AMEX


	Credit Card Number: ________  ________  ________  ________    	Expiration Date: ______

	Signature: ____________________________