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  1. ¬†               CopperHead Software
  2.  
  3. ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî ‚Äî
  4.  
  5. Product Order Form
  6.  
  7. From:                                                                                                                                              Date:
  8.  
  9. ________________________________________                                                _____________________
  10.  
  11. ________________________________________
  12.  
  13. ________________________________________
  14.  
  15. ________________________________________
  16.  
  17. To:     
  18.  
  19. CopperHead Software
  20. 3711 Shamrock West, Suite 176P
  21. Tallahassee FL 32308  ‚Ä¢    24-Hr. Fax: 904-668-9916  ‚Ä¢  e-mail: mnssi@aol.com
  22.  
  23.     Order:    
  24.  
  25.         ____     QuickLOOKups‚Ñ¢ for Macintosh............................................ @ 49.00 each:         ________
  26.         ____     QuickSHIP‚Ñ¢ for Macintosh.................................................... @99.00 each:         ________
  27.         ____     e-CATALOG‚Ñ¢ for Macintosh................................................. @49.00 each:         ________
  28.         ____     TimeClock&SignOut‚Ñ¢ for Macintosh...................................... @19.00 each:         ________
  29.         ____     Checks&Ledger‚Ñ¢ for Macintosh............................................ @39.00 each:         ________
  30.         ____     CD-METER‚Ñ¢ for Macintosh................................................... @49.00 each:         ________
  31.         ____     Bill-IT‚Ñ¢ for Macintosh............................................................ @79.00 each:         ________
  32.         ____     QwikBILL‚Ñ¢(UK)  for Macintosh................. ............................. @49.00 each:         ________
  33.         ____     QwikAUTOBILL‚Ñ¢  for Macintosh............................................ @49.00 each:         ________
  34.         ____     Pro Card Trader‚Ñ¢  for Macintosh................. .................... ...... @20.00 each:         ________
  35.         ____     CS Library‚Ñ¢  for Macintosh.............................................. ...... @49.00 each:         ________
  36.         ____     Invoice&Inventory‚Ñ¢  for Macintosh......................................... @49.00 each:         ________
  37.         ____     Mailing&Memo‚Ñ¢  for Macintosh.............................................. @29.00 each:         ________
  38.  
  39.     Payment by:                                                                                                                                   Shipping:                 $5.00
  40.  [   ] Cash, check or money order;    [   ] Visa;    [   ] MasterCard;
  41.  [   ]School District P.0.#________________________                                 Total Enclosed:       ________
  42.  
  43.     Credit Card Number: ________  ________  ________  ________        Expiration Date: ________
  44.  
  45.                                                            Signature: ____________________________
  46.  
  47. Name on Credit Card  (Please Print): ____________________________