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Text File  |  1991-05-20  |  1.8 KB  |  60 lines
  1.     ---------------------------------------------------------------------
  2.  
  3.                                 Order Form - CDB
  4.  
  5.      
  6.     Name:              _________________________________________________
  7.  
  8.     Company:           _________________________________________________
  9.  
  10.     Address:           _________________________________________________
  11.  
  12.     City, State, Zip:  _________________________________________________
  13.  
  14.     Telephone:         _________________________________________________
  15.  
  16.     Country:           _________________________________________________
  17.  
  18.     E-Mail Address:    _________________________________________________
  19.  
  20.  
  21.     Disk Media:
  22.  
  23.     5 1/4 " diskette     ____
  24.  
  25.     3 1/2 " diskette     ____
  26.  
  27.     Number of Copies     ____  X  $99   = ______________
  28.  
  29.  
  30.     Payment Type:
  31.  
  32.     Check / Money Order  ____
  33.  
  34.     American Express     ____   Card No:       __________________________
  35.  
  36.                                 Expiration:    __________________________
  37.  
  38.                                 Name on Card:  __________________________
  39.  
  40.                                 Signature:     __________________________
  41.  
  42.  
  43.     * New Jersey residents please add %7 sales tax.
  44.     * All checks or money orders must be payable in US Dollars.
  45.  
  46.     COMMENTS: Please feel free to add your thoughts or suggestions!
  47.  
  48.     _____________________________________________________________________
  49.  
  50.     _____________________________________________________________________
  51.  
  52.     _____________________________________________________________________
  53.  
  54.  
  55.     Mail to:                    Daytris
  56.                                 81 Bright Street, Suite 1E
  57.                                 Jersey City, NJ  07302
  58.                                 201-200-0018
  59.  
  60.