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Text File  |  1990-01-03  |  2KB  |  53 lines
  1.                         BSX International Order Form
  2.  
  3.         I wish to register or purchase the following BSX products:
  4.  
  5.                                                          Register  or  Disk
  6.                                                           Purchase ?   size
  7.                                                             Circle     for
  8.                                                              one:   Purchases:
  9.  
  10.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  11.  
  12.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  13.  
  14.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  15.  
  16.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  17.  
  18.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  19.  
  20.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  21.  
  22.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  23.  
  24.                                  For a total of: $______
  25.  
  26.   I've enclosed a check or money order payable to Robert Roberds.
  27.  
  28.   Please ship purchased products to:
  29.                                                              (Please print)
  30.   Name:_____________________________________________________
  31.  
  32.   Street Address:___________________________________________
  33.  
  34.   City, State/Province:_____________________________________
  35.  
  36.   Zip Code:_____________     Country:_______________________
  37.  
  38.   Phone (Optional):_________________________
  39.  
  40.  
  41.   I understand that registered products are  not  to  be  delivered,  while
  42.   purchased products are.
  43.  
  44.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  45.  
  46.              Send this form along with check or money order to:
  47.  
  48.                             BSX International
  49.                             806 Park Ridge Rd. Apt. A8
  50.                             Durham, NC 27713
  51.  
  52.             Please allow 1-2 weeks for delivery of purchases. Thanks!
  53.