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  1.  
  2.  
  3.    Disk Drive Cleaner Order Form
  4. To: 
  5.                                 _____________________________________________
  6. Rosenthal Engineering           name and shipping address
  7. 3737 Sequoia
  8. San Luis Obispo, CA USA
  9.                   93401         _____________________________________________
  10.                                 address
  11.  
  12. ** PLEASE TYPE OR PRINT **
  13.                                 _____________________________________________
  14.  
  15.  
  16.  
  17.                                 _____________________________________________
  18.                                 city, state zipcode (country)
  19. Software registration.
  20.  
  21. (    ) Software (includes one 3 1/2" cleaner kit) $16.50  - - -  _______.____
  22.  
  23.  
  24. (    ) Software (includes one 5 1/4" cleaner kit) $16.50  - - -  _______.____
  25.  
  26. Additional cleaner kits available with registered software only.
  27.  
  28. (    ) 3 1/2" special cleaner kits at $6.50 each  - - - - - - -  _______.____
  29.  
  30.  
  31. (    ) 5 1/4" special cleaner kits at $6.50 each  - - - - - - -  _______.____
  32.  
  33.  
  34.                                                   Subtotal     $________.____
  35.  
  36.  
  37. California residents add 7.25% sales tax on subtotal - - - - -   _______.____
  38.  
  39. Shipping and handling per order add $3.50 for USA, 
  40. Canada and Mexico add $4.75. Others add $5.50  - - - - - - - -      ____.____
  41.  
  42.  
  43. Please pay by check or money order in US funds.- -   Total     $________.____
  44.