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Text File  |  1994-08-31  |  2.0 KB  |  54 lines
  1. ------------------------------------------------------------------------
  2.       Remit to: My Computer Co., POBox 99, Erskineville, NSW 2043
  3. ------------------------------------------------------------------------
  4. Quan            Item                                             Price
  5.  
  6. ___  Telix For Windows v1.00...............   @   $   ea       $________
  7.       (commercial, shrinkwrap package)
  8.  
  9. ___  Telix For Windows Upgrade ............   @   $   ea       $________
  10.       (valid Telix Serial Number or proof of
  11.        purchase from authorized agent required)
  12.  
  13. ___  Telix For Windows Crossgrade .........   @   $   ea       $________
  14.       (proof of purchase of competing and
  15.        commercially available program required)
  16.  
  17. Special Disk Media Requirements:    5.25" [  ]      3.5" [  ]
  18.  
  19. Single Copy Shipping/Handling is:   ------>         Shipping   $________
  20.                 $, via Overnight
  21.  
  22.                                                     Subtotal   $________
  23.  
  24.  
  25.                                                        TOTAL   $________
  26.  
  27. ------------------------------------------------------------------------
  28. Payment by: ( ) Check or MO  ( ) VISA/MC  ( ) PO # _____________________
  29.  
  30.     Name________________________________________________________________
  31.  
  32.  Company________________________________________________________________
  33.  
  34.  Address________________________________________________________________
  35.  
  36.         ________________________________________________________________
  37.  
  38.        Visa/MC orders will be charged in Australian US currency
  39.     The following information is needed for VISA/MC card payments
  40.  
  41.    Phone(______)____________________  Other(______)_____________________
  42.  
  43.   Card #________________________________________  Expiry date___________
  44.  
  45. Name of cardholder______________________________________________________
  46.  
  47. Signature_______________________________________________________________
  48.  
  49.  (VISA/MC orders may call voice: +61 2 565 1991, or fax +61 2 550 4459)
  50.  
  51.  
  52.  
  53.  
  54. aufrm.txt