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  1. ********************************************************************************
  2. *                                                                              *
  3. *                          CHAMPROGRAMMING ORDER FORM                          *
  4. *                                                                              *
  5. ********************************************************************************
  6.  
  7. 1. NAME AND ADDRESS:                       3. CLASSIC GAMES WISH LIST:
  8.  
  9. ______________________________________         1. ____________________________
  10.  
  11. ______________________________________         2. ____________________________
  12.  
  13. ______________________________________         3. ____________________________
  14.  
  15. Phone: (______)____________ Age: _____         4. ____________________________
  16.  
  17. Email: _____________@_________________         5. ____________________________
  18.  
  19. 2. HARDWARE PROFILE:                       4.  HOW WERE YOU INTRODUCED TO
  20.    (Describe your computer system)             CHAMPROGRAMMING?
  21.  
  22. Processor (386/486/Pentium): _________         _______________________________
  23.  
  24.       Do you use a joystick? _________     5.  WHAT DO YOU LIKE MOST ABOUT
  25.                                                                                              CHAMP GAMES?
  26.    Do you have a sound card? _________
  27.  
  28. 6. ORDER INFORMATION:
  29.  
  30.  Quantity  Item Code         Item Description            Unit Price Total Price
  31. --------------------------------------------------------------------------------
  32. |        |   CG05    |   CHAMP KONG                     |  17.95   |           |
  33. |________|___________|__________________________________|__________|___________|
  34. |        |   CG04    |   CHAMP MS. PAC-EM               |  14.95   |           |
  35. |________|___________|__________________________________|__________|___________|
  36. |        |   CG03    |   CHAMP ASTERIODS  (6/96)        |  17.95   |           |
  37. |________|___________|__________________________________|__________|___________|
  38. |        |   CG01    |   CHAMP PAC-EM     (5/96)        |  12.95   |           |
  39. |________|___________|__________________________________|__________|___________|
  40. |        |   CG02    |   CHAMP CENTIPEDE  (5/96)        |  12.95   |           |
  41. |________|___________|__________________________________|__________|___________|
  42. |        |   CG99    |   CHAMP CABLE                    |  17.95   |           |
  43. |________|___________|__________________________________|__________|___________|
  44.    ********************************                                |           |
  45.    *    SATISFACTION GUARANTEED   *                      Subtotal: |___________|
  46.    *                              *                                |           |
  47.    * If, for any reason, you are  *     (CT Residents add 6%) Tax: |___________|
  48.    *   not satisfied, write our   *                                |           |
  49.    * Customer Service Department  *                      Shipping: |___________|
  50.    ********************************                                |           |
  51.                                                   - CHAMP Coupons: |___________|
  52.                                                                    |           |
  53.    Shipping and Handling:                                   Total: |___________|
  54.     -> $2 for first item + $1 for each additional item.
  55.     -> All merchandise will be shipped within 2-4 weeks of purchase!
  56.  
  57.     Send to: CHAMProgramming Inc.
  58.              34-3 Shunpike Road,
  59.              Cromwell, CT 06416                        THANK YOU FOR YOUR ORDER!
  60.