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Text File  |  1994-12-31  |  2KB  |  58 lines
  1.                       XATAX Version 1.01s - Order Form
  2. ******************************************************************************
  3.  
  4. <<<Pixel Painters will keep your personal information strictly confidential>>>
  5.  
  6. General:
  7.  
  8.     First Name:       __________________________________________________
  9.  
  10.     Last Name:        __________________________________________________
  11.  
  12.     Address:          __________________________________________________
  13.  
  14.     City:             __________________________________________________
  15.  
  16.     State:            __________________________________________________
  17.  
  18.     Country:          __________________________________________________
  19.  
  20.     Zip/Postal Code:  __________________________________________________
  21.  
  22.     Phone #:          __________________________________________________
  23.  
  24.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  25.  
  26.     Quantity:    ________ X $17.00                              ________
  27.  
  28.     Sales Tax (VA residents only, please add 4.5%):             ________
  29.  
  30.     Shipping and Handling:                                         $3.00
  31.  
  32.     Foreign Bank Transaction Fee $2.00 (if applicable)          ________
  33.  
  34.     Foreign Order Additional Shipping $1.00 (if applicable)     ________
  35.  
  36.     Total:                                                      ________
  37.  
  38.               ( Note: Please allow 1 to 2 weeks for delivery )
  39.  
  40.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  41.  
  42. Please take the time to tell us how you got your shareware copy of this game:
  43.  
  44. ____ America Online     ____ CompuServe          ____ Prodigy
  45.  
  46. ____ ZiffNet            ____ Software Creations  ____ Friend
  47.  
  48. ____ Local BBS (Name & #): __________________________________________________
  49.  
  50. ____ Catalog (Name): ________________________________________________________
  51.  
  52. ____ CD (Name): _____________________________________________________________
  53.  
  54. ____ Other (Please specify): ________________________________________________
  55.  
  56. *****************************************************************************
  57.   Pixel Painters Corporation * PO Box 2847 * Merrifield * Virginia * 22116
  58.