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Text File  |  1994-12-19  |  3KB  |  50 lines
  1. INNOVATIVE BUSINESS TECHNOLOGIES, INC.   +++++++++++++++++++++++
  2. 7137 SHADY NELMS DRIVE, SUITE #204       | RexxVIM Order Form  |
  3. COLUMBUS, OH 43017                       +++++++++++++++++++++++
  4. VOICE/FAX: (614) 791-9055                                                                    
  5.                                           Date:  _______________
  6.                                                                   
  7. Company Name:  _________________________________________________       
  8.                                                                   
  9. Name:          _________________________________________________       
  10.                                                                   
  11. Address:       _________________________________________________       
  12.                                                                   
  13. City:          ________________________   State:    ____________       
  14.                                                                   
  15. Zip Code:      ________________________   Country:  ____________       
  16.                                                                   
  17. Telephone:     ________________________                                
  18.                                                                   
  19. Fax:           ________________________                                
  20. ================================================================       
  21. For electronic distribution, please list your e-mail address -
  22.                                                                   
  23. CompuServe        Internet         Prodigy        America Online       
  24.                                                                   
  25. Address:       _________________________________________________       
  26. ================================================================       
  27.                                                                   
  28.   Quantity   Product Description           Cost           Total        
  29.                                                                    
  30.   ________   RexxVIM: The VIM Toolkit   $295.00      __________
  31.                                                                  
  32.      Shipping and Handling (International is higher)       4.00
  33.      Ohio Residents add 5.75% Sales Tax              __________        
  34.                                                                   
  35.   TOTAL ORDER                                                          
  36.                                                      ==========        
  37.                                                                   
  38. Please send your completed order form, including a check or            
  39. money order (U.S. Funds only) payable to: Innovative Business          
  40. Technologies, Inc.  For faster service, fax us your order by 
  41. including your credit card information:                                                      
  42.                                                                   
  43. CREDIT CARD:   VISA      MASTERCARD
  44.                                                                   
  45. CREDIT CARD NUMBER: ____________________________________________       
  46.                                                                   
  47. EXPIRATION DATE:    ____________/_______________/_______________       
  48.                                                                   
  49. SIGNATURE:          ____________________________________________
  50.