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Text File  |  1999-09-22  |  584 b   |  12 lines
  1. BILLING INFORMATION:
  2.  
  3. Name:__________________________________ Company:_____________________________
  4. Address:_____________________________________________________________________
  5. City:______________________________ State:__________ Zip/Postal code:_____________
  6. Country:_______________________________ Phone:________________________________
  7. Fax:_______________________________Email:______________________________________
  8.  
  9. Please charge payment to (name on card):________________________________________
  10. VISA/MC. #:_____________________________________________Exp. date:______________
  11.  
  12.