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Text File  |  1995-05-30  |  2KB  |  48 lines
  1.           Order Form for MULTIMEDIA SPELLING BEE - 053195
  2.    Indigo Rose Corporation, P.O. Box 2281, Winnipeg MB, Canada R3C 4A6
  3.  Phone: (800)665-9668 (Canada & US) or (204)668-8180,  Fax: (204)661-6904
  4.  
  5. Name:    ________________________________________________________________
  6.  
  7. Company: ________________________________________________________________
  8.  
  9. Address: ________________________________________________________________
  10.  
  11.      ________________________________________________________________
  12.  
  13. City:    ____________________________  State: ___________________________
  14.  
  15. Country: ____________________________  Zip:   ___________________________
  16.  
  17. Phone:   ____________________________  Fax:   ___________________________
  18.  
  19. Email:   ________________________________________________________________
  20.  
  21. Shipping Method (circle one):    Air Mail     Federal Express
  22.  
  23. Multimedia Spelling Bee:    _______________________ ($34.95 each)
  24.  
  25. Additional Data Disk(s):    _______________________ ($9.95 each or
  26.                              3 for $19.95)
  27. Shipping Costs:             _______________________
  28.  
  29. Subtotal:                   _______________________
  30.  
  31. 7% GST (Canadian residents):_______________________
  32.  
  33. 7% PST (Manitoba residents):_______________________
  34.  
  35. Total:                      _______________________ (US$)
  36.  
  37. Payment Type (circle one):   VISA    American Express    Cheque
  38.  
  39. Cardholder's name:      _________________________________________________
  40.  
  41. Card Number:            _________________________________________________
  42.  
  43. Expiration Date:        _________________________________________________
  44.  
  45. Signature of Cardholder:_________________________________________________
  46. Cardholder will pay total amount shown to card issuer according to 
  47. cardholder agreement with card issuer.
  48.