WINVIEW COPILOT ORDER FORM TO ======================== FROM ===================================== Bremer Corporation Name: ____________________________________ 3401 Cactus Wren Way Austin TX 78746 Company: ____________________________________ 24-Hr Telephone: 512-328-2465 Address: ____________________________________ Compuserve Email: 71614,2556 Internet: zboray@BremerCorp.com City: ____________________________________ State: __________ Zip Code: ______________ Country: ______________ Date: ______________ Daytime Phone #: ____________________________________ FAX #: ____________________________________ Where you found WinView CoPilot: Compuserve _______ Internet _______ BBS _______ Other _________________ PRICING ====================================================================== Individual use: Per user licensing .............. Number of users ______ X $19 ______ Commercial/institution use: Per machine licensing ........ Number of machines ______ X $19 _______ Shipping and handling ........................................... $10 _______ Texas residents add applicable State & County Sales Tax ............. _______ Total ............................................................US$ _______ PAYMENT ====================================================================== Enclose a check drawn on a US bank, a postal money order, or a cashiers check, -- OR -- A signed company/institution purchase order, -- OR -- [ ] Mastercard [ ] Visa [ ] American Express (includes Corporate) Card number _______________________________________ Expiration date ____/____ Signature ____________________________________ ============================================================================== WinView CoPilot Copyright (c) 1995,96 Bremer Corporation (order area: kdb40)