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  1. If possible, please fill out the following form, print, and fax it to DataStream Imaging
  2. Systems, Inc. If this is a problem, please contact us and we will make further arrangements.
  3.  
  4.  
  5. Please Complete The Entire Form
  6.  
  7. Name:
  8. E-mail:
  9. Company:
  10. Address:
  11.  
  12. City:           State: Postal Code:
  13. Phone:
  14.  
  15. ----------------------------------------------------------------------------
  16. Shipping:
  17. FedEx Account:
  18. ----------------------------------------------------------------------------
  19. Payment:
  20. Credit Card Number:                 Exp:
  21. Tax Exemption Number:
  22. Notes:
  23.  
  24.  
  25.                              ORDER INFORMATION
  26.               PRODUCT      QUANTITY        UNIT PRICE SUBTOTAL
  27.  
  28.               WildRiverSSK  _______        $99.95 ea. ________
  29.  
  30.                                                         SHIPPING &  ________
  31.                                                           HANDLING
  32.                                                         SALES TAX   ________
  33.                                              
  34.                                                    (KY residents,
  35.                                                   please add 6%)   ________
  36.  
  37.                                                                TOTAL   ________
  38.  
  39. ----------------------------------------------------------------------------                        
  40.             We welcome comments/suggestions regarding our site.
  41.        You may contact us via: info@datastrem.com or ftp.datastrem.com
  42.                              
  43.  Street Address:  585 West Main St.
  44.                            Lexington, KY
  45.                            40507
  46.  
  47.  Mailing Address: P.O. Box 2148
  48.                            Lexington, KY 
  49.                            40595
  50.  
  51. Telephone #:  (606)255-6686
  52.                 
  53.                              Information By Fax:
  54. Available 24 hours a day, 7 days a week. Call 606-252-2676 or 1-800-889-7781
  55. from a touch-tone phone to request information on our products and services.                              
  56.