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  1.  
  2.     Internet-Connect(TM) Version 1 Mail Order Form
  3.  
  4. Ship to
  5.    Name:________________________________________ 
  6.  
  7. Company:________________________________________ 
  8.  
  9. Address:________________________________________
  10.  
  11.    City:________________________________________
  12.  
  13.   State:___________________ Zipcode:____________
  14.  
  15. Country:________________________________________
  16.  
  17.  
  18. Media Format: [ ] 3.5"     [ ] 5.25"
  19.  
  20. -----------------------------------------------------------------
  21. | Qty.|       Description                 | Unit Price |  Total |
  22. -----------------------------------------------------------------
  23. |     | Internet-Connect Software Package | $ 69.00    |        |
  24. |     |                                   |            |        |
  25. |     | California or Virginia resident   |            |        |
  26. |     |    California 8% state tax        |            |        |
  27. |     |    Virginia 5.5% state tax        |            |        |
  28. |     |                                   |            |        |
  29. |     | Shiping & Handling*               |            |        |
  30. |     |    3-Days Priority                |    7.00    |        |
  31. |     |    Federal Express                |   22.00    |        |
  32. |     |                                   |            |        |
  33. =================================================================
  34.                                                      TOTAL: 
  35.  
  36. * All shipping charges shown are for inside US only. Price per
  37. package. (Please contact Core Systems (tel 510-9435765) for 
  38. international shipping)
  39.  
  40. Please make check payable to Core Systems, and send to:
  41.  
  42. West Coast (Headquarters)
  43.     Core Systems
  44.     PO Box 31022
  45.     Walnut Creek, CA 94598
  46. OR
  47.  
  48. East Coast
  49.     Core Systems
  50.     PO Box 7561
  51.     Arlington, VA 22207
  52.  
  53.  
  54.