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Text File  |  1995-12-31  |  2KB  |  51 lines
  1.                              PC-OHIO ORDER FORM
  2.  
  3. Mail to: PC-Ohio
  4.          PO Box 21411
  5.          South Euclid  OH  44121
  6.  
  7. or FAX to: 216-291-2685
  8.  
  9.  
  10.   -------------------------------------------------------------------------
  11.  | Qt | Item                                               |  Each | Total |
  12.  |-------------------------------------------------------------------------|
  13.  |    | Shareware Extravaganza 4 Best of PC-Ohio 4 CD set  | $19.00|       |
  14.   -------------------------------------------------------------------------|
  15.  |    | Pocket PC Reference 5th edition                    | $14.00|       |
  16.   -------------------------------------------------------------------------|
  17.                                              Shipping and Handling |  3.00 |
  18.                                                                    |-------|
  19.                                                              Total |       |
  20.                                                                     -------
  21.  
  22.                [ ] Check #_____
  23.  
  24.                [ ] VISA              [ ] MasterCard
  25.                [ ] American Express  [ ] Discover
  26.  
  27.  
  28.          Card Number:  _____ _____ _____ _____     Exp. Date:  ___/___
  29.  
  30.  
  31.          Name: _______________________________________________________
  32.  
  33.          Address: ____________________________________________________
  34.  
  35.          City: _______________________________________________________
  36.  
  37.          State / Country: ____________________________________________
  38.  
  39.          Zip / Postal Code: __________________________________________
  40.  
  41.          Home Phone       : ___________________________________
  42.  
  43.          Work Phone       : ___________________________________
  44.  
  45.  
  46. NOTE: ALL Credit Card charges will appear on your monthly Credit Card bill
  47.       as having originated from "PC-Ohio".
  48.  
  49.          Signature:  _________________________________________________
  50.  
  51.