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  1.  
  2.                              FLOATRIS ORDER FORM
  3.                              -------------------
  4.  
  5.  
  6. NAME     _________________________________________________________
  7.           First             Middle              Last
  8.  
  9. ADDRESS  __________________________________________________________
  10.           Number          Street Name                       
  11.  
  12.          _______________________________________(____)_____________
  13.           State              Zip                     Phone
  14.  
  15.  
  16.  
  17. TYPE OF COMPUTER   [] 286  [] 386 [] 486 [] OTHER___________________
  18. VIDEO CARD         _________________________________________________
  19. SOUND CARD         _________________________________________________
  20. MODEM              _________________________________________________
  21. MOUSE              _________________________________________________
  22. JOYSTICK           _________________________________________________
  23.  
  24. DO YOU HAVE     []   3.5 DISK DRIVE   
  25.                 []   5.25 DISK DRIVE 
  26.                 []   BOTH
  27.  
  28. ARE YOU INTERESTED IN MULTI-PLAYER AND OR MODEM GAMES ___________
  29.  
  30. HOW MANY COPIES OF FLOATRIS WOULD YOU LIKE FOR US TO SEND ____ @ $15.00 EACH
  31.  
  32. Please add $1.00 shipping charge if ordering from outside the US.                         
  33. No C.O.D. orders accepted.
  34.  
  35.  
  36. PLEASE SEND CHECK OR MONEY ORDER (U.S. CURRENCY ONLY)
  37. ALONG WITH THIS COMPLETED FORM TO:                   
  38.  
  39. Data Wave  
  40. Suite #457   
  41. 13500 S.W. Pacific Hwy
  42. Portland, Oregon 97223
  43.                    
  44.                         
  45.                         
  46.                         
  47.                         
  48.                         
  49.                         :) THANK YOU FOR YOUR ORDER :)
  50.