home *** CD-ROM | disk | FTP | other *** search
/ Power Game Busters 3 / PGB3.ISO / riptide / order.frm < prev    next >
Text File  |  1994-07-26  |  2KB  |  57 lines
  1.                     PACK MEDIA COMPANY ORDER FORM/FAX FORM
  2.                          Mark items you wish to order 
  3.                                          
  4. -----------------------------------------------------------------------------   
  5.  
  6. [ ] IN SEARCH OF DR. RIPTIDE - The Ultimate Undersea Adventure
  7.     VGA, Sound Blaster support.........................................$25.00
  8.  
  9. -----------------------------------------------------------------------------
  10. "Boxed" Commercial Software:
  11.  
  12. [ ] ELEMENTS - Puzzle/Logic Game
  13.     VGA, Sound Blaster support.........................................$29.95
  14. [ ] METAMORF - The Morphing Graphics Utility
  15.     VGA/SVGA, mouse required...........................................$29.95
  16. [ ] PEA SHOOTIN' PETE - Arcade Fun
  17.     VGA, Sound Blaster support.........................................$19.95
  18.  
  19. -----------------------------------------------------------------------------
  20.  
  21. [ ] PACK MEDIA GAME PACK - Dr. Riptide, Elements, Pea Shootin' Pete 
  22.     Save $10 on this gaming madness....................................$65.00
  23.  
  24. -----------------------------------------------------------------------------
  25. Information: (please print)
  26.  
  27.  
  28. Name ________________________________________________________________________
  29.  
  30. Address (Line 1)_____________________________________________________________
  31.  
  32. Address (Line 2)_____________________________________________________________
  33.  
  34. City ___________________________ State _________________ ZIP/Code ___________
  35.  
  36. Phone/Fax __________________________
  37.  
  38. SHIPPING CHARGES: $4; Each additional item add $1. ($5 for Game Pack)
  39.  
  40. Total payment: $______________   (FLORIDA residents add 6 percent sales tax.)
  41.  
  42. Payment type: [ ] Visa [ ] MasterCard [ ] Check [ ] Money Order
  43.  
  44. Card number: _________________________________________________________________  
  45.  
  46. Expiration date: _____/_____ (MM/YY)  Signature: _____________________________ 
  47.  
  48.  
  49. Mail to:  Pack Media Company, Inc.           Orders: 1-800-628-3266
  50.           P.O. Box 1357                      Visa, MasterCard are welcome.
  51.           Pompano Beach, FL  33061-1357      Or E-Mail a credit card order
  52.                                              to us at packmedia@aol.com  
  53.  
  54.           Make checks payable to "Pack Media Company, Inc."  
  55.  
  56.           Thank you!
  57.