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Text File  |  1996-10-17  |  3KB  |  64 lines
  1. ORDER FORM
  2.  
  3. SYNTEGRATION INC.
  4. 3811 Schaefer Avenue #J, Chino, California 91710, U.S.A.
  5. Tel: 1-909-464-9450  Fax: 1-909-627-3541  E-mail:73707.3331@compuserve.com
  6. URL: http://www.primenet.com/~syntegrn
  7.  
  8. BILLING NAME AND ADDRESS:              SHIPPING NAME AND ADDRESS:
  9. --------------------------             --------------------------
  10.  
  11. __________________________________     ______________________________________
  12.  
  13. __________________________________     ______________________________________
  14.  
  15. __________________________________     ______________________________________
  16.  
  17. __________________________________     ______________________________________
  18.  
  19. __________________________________     ______________________________________
  20.  
  21. Tel:______________________________     Fax:__________________________________
  22.  
  23. SALES TAX
  24. California residents add 7.75% of subtotal for sales tax
  25.  
  26. PAYMENT METHOD                         SHIPPING FEE
  27.  
  28. ___ Check or Money Order enclosed      ___ $8  Standard service in the US
  29.                                        ___ $10 Standard service to Canada
  30. Credit Card:                           ___ $15 2 Day service in the US
  31. ___ VISA                               ___ $21 Overnight service in The US
  32. ___ Mastercard                         ___ $30 Express Service to Canada
  33. ___ Discover                           ___ $60 Express Service Worldwide
  34.  
  35. Card Number:______________________     Expiration Date:______________________
  36. Cardholder
  37. Name:_____________________________     Signature:____________________________
  38.  
  39. Quantity   Description                              Unit Price         Amount
  40. --------   --------------------------------------   ----------  -------------
  41.  
  42. ________   Traveling Workplace for OS/2                 $69.95  _____________
  43.  
  44. ________   The Secure Workplace for OS/2                $79.95  _____________
  45.            Standard Edition
  46.  
  47. ________   The Secure Workplace for OS/2               $120.00  _____________
  48.            Professional Edition
  49.            (includes Traveling Workplace and
  50.             File Access Control)
  51.  
  52. ________   The Secure Workplace STD Upgrade             $29.95  _____________
  53.            (registered users only)
  54.  
  55. ________   The Secure Workplace PRO Upgrade             $45.00  _____________
  56.            (registered users only)
  57.                                                       SUBTOTAL  _____________
  58.  
  59.                                                      SALES TAX  _____________
  60.  
  61.                                                       SHIPPING  _____________
  62.  
  63.                                                          TOTAL  _____________
  64.