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Text File  |  1994-04-07  |  2.9 KB  |  64 lines
  1. WinDisKlone  ORDER FORM   (MAIL or FAX in)    Updated 04/07/94
  2. For more information, see EZXINFO.EXE, SUPPORT.EXE & ORDRFORM.EXE
  3.  
  4. MAIL TO:  EZX Publishing & Distributing      (EZX Corporation)
  5. PO Box 58177, Attention Dept.WDK501, Webster (Houston), TX  77598-8177  USA
  6.  
  7. FAX to:1-713-280-0099 (24 hours) and/or Voice:1-713-280-9900 (Business Hours)
  8.        ~~~~~~~~~~~~~~
  9. SHIP ORDER TO:
  10.      Company Name ____________________________________________________________
  11.  
  12.      YOUR NAME _______________________________________________________________
  13.  
  14.      ADDRESS _________________________________________________________________
  15.  
  16.  City, ST, Zip, Country ______________________________________________________
  17.  
  18.   Phones:   Voice:_________________________   FAX:____________________________
  19.   (with area codes)                         OTHER:____________________________
  20.  
  21. IF above address is not the billing address (where the bill is received) for
  22. your credit card, please enter same here:
  23.  
  24.  
  25. Type (V/MC/Disc/Amex):         ___________________________________  ________
  26.                                                                     Exp.Date
  27. Card Number (13 or 16 digits): ___________________________________ 
  28.  
  29. Name that appears on card:     ___________________________________
  30.  
  31. Is this a Company Card ?  [ ] Y/N  Name on card if so? ________________________
  32.  
  33. *Signature* (required):        x___________________________________
  34.  
  35.                                                         Unit         
  36. ITEM DESCRIPTION                             Quantity   Price       TOTALS
  37. ^^^^^^^^^^^^^^^^                             ^^^^^^^^   ^^^^^       ^^^^^^
  38. WinDisKlone (Single User; 3.5") for Windows  ________  _$59.00_    ________
  39. (only available on 3.5" disk)       3.1+               per user
  40. ___________________________________________  ________  ________    ________
  41.  
  42. ___________________________________________  ________  ________    ________
  43.  
  44. ___________________________________________  ________  ________    ________
  45.  
  46. ___________________________________________  ________  ________    ________
  47.  
  48. ___________________________________________  ________  ________    ________
  49.  
  50. ___________________________________________  ________  ________    ________
  51.  
  52. ___________________________________________  ________  ________    ________
  53.  
  54. ___________________________________________  ________  ________    ________
  55.  
  56. ___________________________________________  ________  ________    ________
  57.  
  58. CC App. Code:                                 PRODUCT SUB-TOTAL    ________
  59. Check #:   ($7/USA48; $12/AK,HI,PR,CDN; $24 Elsewhere)-SHIPPING    ________
  60. Amount:                          "TAX" TOTAL INCLUDING SHIPPING    ________
  61. Tax Exempt #:           8.25% Sales Tax (TEXAS ONLY, see above)    ________
  62. (Requires state certificate.)
  63.                                                     ORDER TOTAL    ________
  64.