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ORDERFRM.DOC
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1990-01-31
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1KB
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34 lines
Mail To: Dialog Software
Orders Department
Box 9889 at 1101 Wilson Boulevard
Arlington, Virginia 22209-0889
ORDER FORM:
Date ___________________
Full Name ____________________________________________________
Company ____________________________________________________
SHIPPING Address1 ____________________________________________
SHIPPING Address2 ____________________________________________
SHIPPING Address3 ____________________________________________
City _________________ State ____ Full Zip ______________
Mailing Address1 _____________________________________________
Mailing Address2 _____________________________________________
Mailing Address3 _____________________________________________
City _________________ State ____ Full Zip ______________
DAYTIME Phone _______________
Terms of Payment (VISA, MC, Check) ___________________________
Card Number __________________________________________________
Expiration Date ______________________________________________
EXACT Name on card (if different from above) _________________
Each Copy of DiaLogic is $79.95.
Shipping in US is $6.00; Overseas is $15.00.
VIRGINIA residents are taxed at 4.5%.