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Text File  |  1991-08-27  |  5KB  |  65 lines
  1. ================================================================================
  2. | Send Orders to:              | INVOICE/REG. NO.      |                       |
  3. |  E Z X   P u b l i s h i n g |                       | YOUR P.O. OR OTHER NO |
  4. | 17077 Texas Av.  BOX 58177   |-----------------------+-----------------------|
  5. | WEBSTER, TX 77598  USA       |DATE:                  |REF/EXT:               |
  6. |                              |-----------------------------------------------|
  7. |-------------------------------Eff.09/91    U P S SHIPPER # T X  X X X- X X X |
  8. |-------------------------------------------  Red Label? [  ]    ZONE [      ] |
  9. | SOLD TO: (ATTN: ACCOUNTS PAYABLE)        |  Blue Label?[  ]                  |
  10. |------------------------------------------|  Ground?    [  ]   WEIGHT[      ] |
  11. |                                          |  Mail?      [  ]                  |
  12. |                                          |  Insured?   [  ] $                |
  13. |                                          |  Certified? [  ]  See rates below.|
  14. |                                          |  Other?     [  ]  S&H is $7 min.  |
  15. |                                          | ----------------------------------|
  16. |                                          | |SPECIAL INSTRUCTIONS:            |
  17. |------------------------------------------- |                                 |
  18. |^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^# |You may order with your VISA,    |
  19. |  S H I P  T O : (IF DIFFERENT THAN ABOVE)# |MasterCard, American Express, or |
  20. |------------------------------------------# |Discover credit card by calling: |
  21. |                                          # | 1-800-800-2468 ext.EZX TollFree!|
  22. |                                          # | FAX:1-713-280-0525              |
  23. |                                          # |      For any other information  |
  24. |                                          # |including p.o.s and site licen-  |
  25. |                                          # |sing, etc. call: 1-713-280-9900  |
  26. |                                          # |FAX This FORM for ORDERS or INFO |
  27. |                                          # | TO FAX: 1-713-280-0525 (24hrs)  |
  28. |..........................................#-----------------------------------|
  29. |TERMS: PAYMENT DUE ON DELIVERY. OTHER?                      SOLD BY:          |
  30. |------------------------------------------------------------------------------|
  31. |TAX EXEMPT?        REASON:          TAX #                   EXT:              |
  32. |------------------------------------------------------------------------------|
  33. |CONTACT:                           DATE:             TEL# (     )             |
  34. |------------------------------------------------------------------------------|
  35. |V/MC/AX/D #                              EXP. DATE:   /    AUTH CODE.         |
  36. |(SPECIFY) Cardholder Name:                                               PROC?|
  37. |TEL #S REQD: DAY/OFC    -          FAX    -         HM    -               ----|
  38. |------------------------------------------------------------------------------|
  39. |SOURCE OF ORDER?                    |Signature Required!                      |
  40. |==============================================================================|
  41. |   ITEM  (All products include manual)     |Quantity| Price  |    EXTENSION   |
  42. |----------------------------------------------------+--------+----------------|
  43. |                                             |      |$       |                |
  44. |---------------------------------------------+------+--------+----------------|
  45. |                                             |      |$       |                |
  46. |---------------------------------------------+------+--------+----------------|
  47. |                                             |      |$       |                |
  48. |---------------------------------------------+------+--------+----------------|
  49. |                                             |      |        |                |
  50. |---------------------------------------------+------+--------+----------------|
  51. |                                             |      |        |                |
  52. |---------------------------------------------+------+--------+----------------|
  53. | Prices are subject to change without notice.| CALL |        |                |
  54. |-------------------------------------------------------------+----------------|
  55. |S&I:$7 min.|$12-2day/US48|CANADA/APO/FPO/HI/AK/PR,$12|Fgn.$24|                |
  56. |-------------------------------------------------------------+================|
  57. |Add $2 for each addl. item. POs accepted from govt|SUB-TOTAL |                |
  58. |& rated companies. ($50 minimum) ----------------------------+================|
  59. |USA Checks only. 10 days to clear|SalesTax 8.25% TX must add.|                |
  60. |---------------------------------+---------------------------+----------------|
  61. |Amt.Rcvd.     Ck#      Due       |Shipping & Insurance Above |                |
  62. |-------------------------------------------------------------+----------------|
  63. |1-orig/2-label/3-customer/4-packing    THANK YOU! |    TOTAL |                |
  64. ================================================================================
  65.