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  1. *********************************************************************
  2. *               LIMITED-TIME OFFER : SPECIAL ORDER FORM               *
  3. *             HAYES V-series Modem Enhancer (w/CCITT V.42)          *
  4. *                         USA Delivery - Only                                    *
  5. *                                                                                        *
  6. *                                                                                        *
  7. * This Special Order Form, downloaded from a Hayes Registered BBS     
  8. *
  9. *                must be completed and mailed to:                             *
  10. *                                                                                         *
  11. *        Hayes Microcomputer Products, Inc                                    *
  12. *        Attn: Sysop Support Program Coordinator                              *
  13. *        P.O. Box 105203                                                          *
  14. *        Atlanta, GA  30348                                                       *
  15. *                                                                                         *
  16. *  Customer 
  17. Name:_________________________________________________        *
  18. *  Customer 
  19. Address:______________________________________________         *
  20. *                   ______________________________________________  *
  21. * City, State, Zip: ____________________________________________    
  22. *
  23. * Phone Number:   (______) __________________________              *
  24. * Order Date: ___________________                                             *
  25. *                                                                                         *
  26. *                                                                                         *
  27. *  QTY              Description              Each     TOTAL                       *
  28. * ====  =================================  ======   ========          
  29. *
  30. * ____  V-series Modem Enhancer (V.42)     $159.00  ________       *
  31. *                                                                     *
  32. * ____  Cable,Modem Enhancer to Smartmodem $ 32.95  ________          
  33. *
  34. *                                                                     *
  35. *       Georgia Customers add 5% sales tax.......   ________                   *
  36. *                                       ====================                       *
  37. * Shipping & Handling is included.        TOTAL:   $________             *
  38. *                                                                                          *
  39. * PAYMENT TERMS: Payment for the entire amount of the purchase 
  40. must                                                *
  41. * be included with this order form. You may pay by check, money 
  42. order,                                             *
  43. * MasterCard, VISA, or bank transfer.                                          *
  44. *  [ ] Check                 Credit Card # _________________________      *
  45. *  [ ] Money Order                                                                     *
  46. *  [ ] MasterCard            Expiration Date: ______________________   *
  47. *  [ ] VISA                                                                            *
  48. *  [ ] Bank Transfer         Credit Card Signature__________________ *
  49. *  Name -EXACTLY- as printed on Credit Card 
  50. ________________________                              *
  51. *                                                                                         *
  52. *  DOWNLOADED FROM:       Bulletin Board Name                            *
  53. *                         Sysops Name                                                 *
  54. *                         Mailing Address                                         *
  55. *                         City,State, Zip                                             *
  56. *                                                                                         *
  57. * Hayes reserves the right to cancel this offer at any time, as well  *
  58. * as refuse the order request if sent in without a properly completed 
  59. *
  60. * Special Order Form. Please allow 4 to 6 weeks for delivery.          *
  61. ***********************************************************************
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