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Text File  |  1993-05-24  |  1KB  |  51 lines
  1.                    F S A    O R D E R    F O R M
  2.                                 
  3.                                 
  4. Name____________________________________________________________
  5.  
  6. Company_________________________________________________________
  7.  
  8. Address__________________________________________________________
  9.  
  10. City___________________________________  State________
  11.  
  12. Zip_________
  13.  
  14. Telephone____________________   (For questions about your order)
  15.  
  16.  
  17. Product(s):   ____   StickEm                    
  18.      
  19.               ____   King's Corners
  20.      
  21.               ____   HexView
  22.  
  23.  
  24. Diskette format: (Check one)     ____ 3.5"      ____ 5.25"
  25.  
  26. Quantity: ______ copies at $10.00 each.........    $__________
  27.  
  28. Shipping: ($2.00 per copy).....................    $__________
  29.  
  30. Order total....................................    $__________
  31.  
  32.  
  33. Payment method (Check one):   ____ Check or money order
  34.                               ____ MasterCard
  35.                               ____ Visa
  36.  
  37.  
  38. For credit card orders only, please provide the following:
  39.  
  40. Card number _____________________________________________
  41.  
  42. Expiration date ________________
  43.  
  44. Signature________________________________________________
  45.  
  46.  
  47.  
  48. Return this form to: Financial Systems Associates, Inc.
  49.                  148 N. Washington St.
  50.                      Delaware, Ohio  43015
  51.