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Text File  |  1990-04-04  |  2KB  |  44 lines
  1.  
  2.  
  3.                          Print the file ORDER.DOC
  4.  
  5.                   E Q U A T O R   O R D E R   F O R M
  6.  
  7.       MAIL TO: Pulse Research                     Telephone:
  8.                P.O. Box 696                       (802) 985-2928
  9.                Shelburne, Vermont, 05482, USA.
  10.      ---------------------------------------------------------------------
  11.       Mastercard:___   Visa:___     Check:___ (U.S. FUNDS ONLY)
  12.  
  13.       Card Number:________________________________  Expiration:__________
  14.  
  15.       Name:______________________________ Signature:_____________________
  16.  
  17.       Company Name:_______________________________
  18.  
  19.       Address:____________________________________
  20.  
  21.       City:____________________________  State:____  Zipcode:____________
  22.  
  23.       Country:______________________________    Phone:(____)_____________
  24.  
  25.      ---------------------------------------------------------------------
  26.       ITEMS ORDERED                              QTY  PRICE    AMOUNT
  27.      ------------------------------------------------------------------
  28.  
  29.              or EQUATOR        (Registered copy)  -   $29.00   $
  30.  
  31.              Application packs         each            10.00   $
  32.              ( please list packs required )
  33.  
  34.  
  35.       ADD Shipping/Handling charge $ 2.00                      $ 2.00
  36.  
  37.                                                         TOTAL  $
  38.  
  39.  
  40.              Where did you learn about EQUATOR
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  43.      --------------------------------------------------------------------
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