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  1. ------------------------------------------------------------------------
  2. Remit to: deltaComm Development, Inc., PO Box 1185, Cary, NC  27512  USA
  3. ------------------------------------------------------------------------
  4. Quan            Item                                            Price
  5.  
  6. ___  Telix For Windows v1.00...............     @ US$ 119 ea   $________
  7.       (commercial, shrinkwrap package)
  8.  
  9. ___  Telix For Windows Upgrade ............     @ US$ 49 ea    $________
  10.       (valid Telix Serial Number or proof of
  11.        purchase from authorized agent required;
  12.  
  13. ___  Telix For Windows Crossgrade .........     @ US$ 69 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   $________
  20. USA:           : US$ 10,
  21. Elsewhere      : US$ 15,
  22.  
  23.                                                     Subtotal   $________
  24.  
  25.        N. Carolina residents please add State Sales Tax (6%)   $________
  26.  
  27.                                                        TOTAL   $________
  28.  
  29. ------------------------------------------------------------------------
  30. Payment by: ( ) Check or MO  ( ) VISA/MC  ( ) PO # _____________________
  31.  
  32.     Name________________________________________________________________
  33.  
  34.  Company________________________________________________________________
  35.  
  36.  Address________________________________________________________________
  37.  
  38.         ________________________________________________________________
  39.  
  40.             Visa/MC orders will be charged in US currency
  41.     The following information is needed for VISA/MC card payments
  42.  
  43.    Phone(______)____________________  Other(______)_____________________
  44.  
  45.   Card #________________________________________  Expiry date___________
  46.  
  47. Name of cardholder______________________________________________________
  48.  
  49. Signature_______________________________________________________________
  50.  
  51.    (VISA/MC orders may call voice: 800-TLX-8000, or fax 919-460-4531)
  52.  
  53.  
  54.  
  55. eefrm.txt