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Text File  |  1993-08-31  |  2KB  |  78 lines
  1. POWERTIME 1.00 ORDER FORM
  2. -------------------------
  3.  
  4.  NuIQ Software, Inc.
  5.  Post Office Box 832
  6.  Larchmont, New York 10538 USA
  7.  
  8.  Tel: (914) 833-3479  Fax: (914) 833-3623
  9.  
  10.  Quantity       Description                     Each       Total
  11.  --------       -----------                     ----       -----
  12.  
  13.  _______        PowerTime Chart Program         $15        _____
  14.  
  15.                 Shipping And Handling:
  16.  
  17.                 $5 first item, $2 each add'l in USA 48 States
  18.  
  19.                 $12 first item, $2 each add'l in AK, HI, PR, VI,
  20.                 GU, AS, FPO, APO and Canada
  21.  
  22.                 $24 first item, $4 each add'l overseas     _____
  23.  
  24.                 SALES TAX:
  25.  
  26.                 NY residents add sales tax for your county _____
  27.  
  28.  
  29.                 TOTAL                                      _____
  30.  
  31.  
  32. If ordering by check, please make checks payable to: NUIQ SOFTWARE INC.
  33.  
  34. If you would like to order by credit card, orders may be placed
  35. by telephone at 914-833-3479 or by fax at 914-833-3623.
  36.  
  37. For mail orders by credit card, please complete the following
  38. information:
  39.  
  40. Cardholder:   ______________________________________________________
  41.  
  42. Card Type:    VISA  /   MASTERCARD   /  DINERS CLUB  / CARTE BLANCHE
  43.  
  44. Card Number:  ______________________________________________________
  45.  
  46. Expiration:   ______________________________________________________
  47.  
  48. Signature:    ______________________________________________________
  49.  
  50.  
  51.  
  52.  Date:        ___/___/_____
  53.  
  54.  Name:        ______________________________________________________
  55.  
  56.  Company:     ______________________________________________________
  57.  
  58.  Address:     ______________________________________________________
  59.  
  60.               ______________________________________________________
  61.  
  62.  Phone:       ______________  Fax: ____________ BBS: _______________
  63.  
  64.  Disk Type:   5.25" _____________  or  3.5" _____________
  65.  
  66.  
  67.  How did you hear about PowerTime:
  68.  
  69.  ___________________________________________________________________
  70.  
  71.  ___________________________________________________________________
  72.  
  73.  Comments:
  74.  
  75.  ___________________________________________________________________
  76.  
  77.  ___________________________________________________________________
  78.