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ORDER.DOC
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1991-04-18
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2KB
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59 lines
H Y P E R P A D O R D E R F O R M
RETURN WITH PAYMENT TO:
Brightbill-Roberts & Co. Phone : (315) 474-3400
421 University Building Fax : (315) 472-1732
Syracuse, NY 13202 BBS : (315) 472-1058
Compuserve : 75300,363
Name:_______________________________ Phone: __________________________
Company:______________________________________________________________
Address: ________________________________________ Suite/Apt.__________
City: ___________________________, State: _________ ZipCode:__________
Quantity: ________ Normal HyperPAD Registration $ 99.00 ________
________ Overnight Shipping (USA) $ 25.00 ________
________ Foriegn Shipping $ 35.00 ________
Subtotal ________
NY residents add sales tax ________
Shipping and handling charge within USA $ 5.00
TOTAL ________
[] Check enclosed. Make payable to Brightbill-Roberts & Co.
or: Charge my [] Visa [] MasterCard [] American Express [] Discover
Card No.: ______________________________________ Exp.: __________
Name on credit card if different from above:
_______________________________________________________
Your signature:___________________________________