You have chosen to pay by cash or check, but you’re ordering by fax or email. You haven’t chosen a product to order. Your card has expired, according to the expiration date you entered. The card expiration date you entered is invalid or is not in the correct format (MM/YY). The Visa or MasterCard number you entered is invalid or in the wrong format. It must be either four groups of four numbers, or one group of four and three groups of three. You have chosen to pay with a Visa or MasterCard, but you haven’t typed in the card expiration date. You have chosen to pay with a Visa or MasterCard, but you haven’t typed in the card number. Please type in your postal code before printing the order form. Please type in your city before printing the order form. Please type in your street address before printing the order form. Please type in your name before printing the order form. Unknown printing error. Make sure you have chosen a printer in the Chooser, and that the printer driver is installed. When reporting this problem, please mention error number: Unable to write to the disk. High Risk Ventures Order Form Save order form as: Please add $4 for shipping non-Green commercial products outside the U.S. (except Canada and Mexico). All orders are shipped via first class U.S. mail. Please allow two weeks for delivery within the U.S., and three weeks for delivery outside the U.S. Call (800) 927-0771 or (503) 746-0771 if you have any questions. Email this form to one of the following: America Online: High Risk CompuServe: 75110,2673 Internet: highrisk@aol.com Fax this form to (503) 746-0747. Mail this form with payment to: High Risk Ventures PO Box 70690 Eugene, Oregon 97401-9610 USA Thank you! System Code: Serial Number: Date: Signature: Expiration date: Credit card number: Cash enclosed. Send me a billing invoice. A check or money order is enclosed. Please charge my MasterCard Please charge my Visa Amount Due: Quantity Discount: each. . at copies of copy of Please send me AppleLink Internet Delphi Genie CompuServe America Online None Email: Telephone: Country: Postal Code: State: City: Street: Street: Name: Save As... Print... MM/YY XXXX-XXXX-XXXX-XXXX We will send you a billing invoice, with payment due upon receipt. We will send your order when we receive your payment. Make the check or money order payable to High Risk Ventures. You may send cash, but it is not recommended. We cannot be responsible for lost or tampered mail. $ Electronic Mail Address Telephone Number Country Postal / Zip Code State / Province / Territory City Street Address Line 2 Street Address Line 1 Your Name