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1996-01-04
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48 lines
Infinitris v1.0 Order Form
──────────────────────────
-----------------------------------Cut Here----------------------------------
Name________________________
Street Address_______________________________________
City______________________ State____ Zip Code_______
Country______________________________________________
Phone (____)_____________ Fax: (____)_____________
InterNet E-Mail (if available) ______________________________________
Please specify media size: [ ] 720KB 3 1/2
[ ] 1.44MB 3 1/2
[ ] 1.2MB 5 1/4
Qty Product Name Price
--- ------------ -----
___ Infinitris v 1.0 @ $15 = _____
Shipping and Handling $3 = _____
Sub-Total = _____
Residents of NY State add
8.25% sales tax = _____
Total = _____
-----------------------------------Cut Here----------------------------------
Make checks or money orders payable to:
Leizer Portnoy
2940 Ocean Ave. Apt #A6
Brooklyn, NY 11235
USA
Thank you for registering!