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Text File  |  1990-01-31  |  1KB  |  34 lines
  1. Mail To:      Dialog Software
  2.               Orders Department
  3.               Box 9889 at 1101 Wilson Boulevard
  4.               Arlington, Virginia 22209-0889
  5.  
  6.  
  7. ORDER FORM:
  8.  
  9. Date ___________________
  10.  
  11. Full Name ____________________________________________________
  12. Company   ____________________________________________________
  13.  
  14. SHIPPING Address1 ____________________________________________
  15. SHIPPING Address2 ____________________________________________
  16. SHIPPING Address3 ____________________________________________
  17. City _________________     State ____  Full Zip ______________
  18.  
  19. Mailing Address1 _____________________________________________
  20. Mailing Address2 _____________________________________________
  21. Mailing Address3 _____________________________________________
  22. City _________________     State ____  Full Zip ______________
  23.  
  24. DAYTIME Phone _______________
  25. Terms of Payment (VISA, MC, Check) ___________________________
  26.  
  27. Card Number __________________________________________________
  28. Expiration Date ______________________________________________
  29. EXACT Name on card (if different from above) _________________
  30.  
  31. Each Copy of DiaLogic is $79.95.
  32. Shipping in US is $6.00; Overseas is $15.00.
  33. VIRGINIA residents are taxed at 4.5%.
  34.