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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...............   @ $99 US    ea   $________
  7.       (commercial, shrinkwrap package)
  8.  
  9. ___  Telix For Windows Upgrade ............   @ $49 US    ea   $________
  10.       (valid Telix Serial Number or proof of
  11.        purchase from authorized agent required;
  12.  
  13. ___  Telix For Windows Crossgrade .........   @ $69 US    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.                    $10, via Next Day Fed Ex
  21.  
  22.                                                     Subtotal   $________
  23.  
  24.        N. Carolina residents please add State Sales Tax (6%)   $________
  25.  
  26.                                                        TOTAL   $________
  27.  
  28. ------------------------------------------------------------------------
  29. Payment by: ( ) Check or MO  ( ) VISA/MC  ( ) PO # _____________________
  30.  
  31.     Name________________________________________________________________
  32.  
  33.  Company________________________________________________________________
  34.  
  35.  Address________________________________________________________________
  36.  
  37.         ________________________________________________________________
  38.  
  39.             Visa/MC orders will be charged in US currency
  40.     The following information is needed for VISA/MC card payments
  41.  
  42.    Phone(______)____________________  Other(______)_____________________
  43.  
  44.   Card #________________________________________  Expiry date___________
  45.  
  46. Name of cardholder______________________________________________________
  47.  
  48. Signature_______________________________________________________________
  49.        (VISA/MC orders may call voice: 800-TLX-8000, or fax 919-460-4531
  50.  
  51.  
  52.  
  53. usfrm.txt
  54.