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  1.  
  2.  
  3.                                IMAGE ORDER FORM
  4.  
  5.        ****************************************************************
  6.                             IMAGE Computer Systems
  7.                                 P. O. Box 647
  8.                                 Avon, CT 06001
  9.                               Ph: (203) 678-8771
  10.        ****************************************************************
  11.  
  12.         Name                        ___________________________________
  13.  
  14.         Company                     ___________________________________
  15.  
  16.         Address                     ___________________________________
  17.  
  18.         Address, Zip Code           ___________________________________
  19.  
  20.         Daytime phone number        ___________________________________
  21.  
  22.  
  23.         __ ImagePrint Version 4 Registration Disk              $42.95
  24.            Latest version, 25 fonts, printed manual
  25.  
  26.  
  27.         __ The IMAGE Printing Utilities                        $52.95
  28.            Described in appendix section of documentation.
  29.            Includes memory-resident Metatext, ImagePrint,
  30.            25 fonts, printed manual
  31.  
  32.  
  33.         SHIPPING AND HANDLING FOR ALL ORDERS                    $3.00
  34.  
  35.         
  36.         Add $3.00 to cover cost of air mail shipping
  37.         if you are outside of North America                 __________
  38.  
  39.  
  40.                                                  Subtotal   __________
  41.  
  42.                    Connecticut residents add 8% sales tax   __________
  43.  
  44.                                                Total        __________
  45.  
  46.  
  47.  
  48.         Diskette size:   ____ 5 1/4 (360K)   or    ____ 3 1/2 (720K)
  49.  
  50.         Payment is by:
  51.  
  52.         __ Check (MUST be payable in US funds from a US bank)
  53.         
  54.         __Money order/Bank draft   __ MasterCard      __Visa
  55.  
  56.         Card number _______________________ Expiration date ___________
  57.  
  58.         Card Holder Signature _________________________________________
  59.  
  60.         Card Holder Name (Please Print) _______________________________
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