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Text File  |  1997-03-26  |  1.7 KB  |  43 lines
  1.  Product # 11734           WinCharging                Order Form 
  2. -----------------------------------------------------------------
  3.  Qty
  4.  ___ WinCharging Deluxe Edition         @ $24.95 each  $________
  5.                  NJ residents please add 6% sales tax  $________
  6.      Shipping and handling  charges  --
  7.                 - in United States  $___4.00_
  8.                 - in Canada         $___6.00_
  9.                 - elsewhere         $__12.00_
  10.                                 Shipping and handling  $________
  11.  
  12.                                                 Total  $________
  13. -----------------------------------------------------------------
  14.  Disk size (check one):  [ ] 3.5 HD (default)       [ ] 5.25 HD
  15. -----------------------------------------------------------------
  16.  Indicate payment type:   [ ] Personal check    [ ] Money order
  17.  Checks and MO's must be drawn on U.S. banks in U.S. funds.
  18.  
  19.  Please make payable to My Little Realm Enterprises and mail to:
  20.  
  21.                 My Little Realm Enterprises
  22.                 22 Church Street #103, Suite 376
  23.                 Ramsey, New Jersey 07446
  24. -----------------------------------------------------------------
  25.  
  26.  User Information
  27.  
  28.       Name_______________________________________________________
  29.  
  30.    Company_______________________________________________________
  31.  
  32.    Address_______________________________________________________
  33.  
  34.       City_______________________________________________________
  35.  
  36.      State______________________________________ Zip_____________
  37.  
  38.       Home_(_____)_________________ Bus._(_____)_________________
  39.  
  40.    EMail Address_________________________________________________
  41.  
  42. _____________________________________________________R032396SWV20
  43.