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  1. Aptiva Special Upgrade Order Form
  2.  
  3. Name: _______________________________  Ship to: __________________________
  4. Address: ____________________________  Address: __________________________
  5. City: _______________________________  City: _____________________________
  6. State: ______________________________  State: ____________________________
  7. Postal/Zip Code: ____________________  Postal/Zip Code: __________________
  8. Country: ____________________________  Country: __________________________
  9. Phone #:_____________________________  Phone #: __________________________  
  10.  
  11. Product name:                 Suggested  Special        Unit
  12.                  Price        Price         Qty.   Total
  13. TriplePlay Plus! English     $99.95        $44.95     X    ____ = $ ______
  14. TriplePlay Plus! French         $99.95        $44.95     X    ____ = $ ______
  15. TriplePlay Plus! German         $99.95        $44.95     X    ____ = $ ______
  16. TriplePlay Plus! Hebrew         $99.95        $44.95     X    ____ = $ ______
  17. TriplePlay Plus! Italian     $99.95        $44.95     X    ____ = $ ______
  18. TriplePlay Plus! Japanese     $99.95        $44.95     X    ____ = $ ______
  19. TriplePlay Plus! Spanish         $99.95        $44.95     X    ____ = $ ______
  20. Family Language Pack - Spanish     $214.80        $89.95     X    ____ = $ ______
  21. Family Language Pack - French    $214.80        $89.95     X    ____ = $ ______
  22. Family Language Pack - English    $214.80        $89.95     X    ____ = $ ______
  23.                                 Product subtotal = $ ______
  24. For products shipped to NY State please add sales tax:          + $ ______
  25. For orders shipped in the U.S. add $4.95 per order:              + $ ______
  26. For orders shipped outside the U.S. add $12.95 per order:     + $ ______
  27.                                                ORDER TOTAL   = $ ______
  28. Payment information: ___Mastercard  ___Visa  ___Discover  ___American Express
  29. Expiration date:___/___
  30. Cardholder name: _________________________ Card #:_________________________
  31. Cardholder signature: ___________________________  
  32. MAIL ORDER FORM TO:        FAX ORDER FORM OR CALL IN ORDER TO:
  33. APTIVA SPECIAL UPGRADE OFFERS    (800) SYRLANG (797-5264) - U.S. toll-free telephone
  34. Syracuse Language Systems       (315) 478-6729 - Telephone from outside U.S.
  35. 719 E. Genesee Street          (315) 478-6902 - Fax
  36. Syracuse, NY 13210 U.S.A.    
  37.  
  38. Prices are in U.S. funds. Please allow 4 weeks for delivery. Syracuse 
  39. Language Systems reserves the right to limit quantities. Offer only 
  40. available to IBM Aptiva owners on orders received by mail, fax, or 
  41. phone directly to Syracuse Language Systems, on or before 2/28/98. Offer 
  42. not valid in conjunction with any other discount or special offer.