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Text File  |  1997-12-29  |  1.3 KB  |  47 lines
  1. Artishock, Inc., Order Form
  2.  
  3. Mail this Form along with your payment to:
  4.  
  5. Artishock, Inc.
  6. 520 Madison Ave., 38th Floor
  7. New York, NY 10022
  8. USA
  9.  
  10. Billing Address:
  11.  
  12. Name:     ___________________________
  13. Address:  ___________________________
  14. City:     ___________________________   State/Prov.: _____________
  15. Zip:      ___________________________   Country:     _____________
  16. Tel.:     ___________________________   
  17.  
  18. I would like to receive my registration number by e-mail:  Yes / No
  19.  
  20. E-Mail:   ___________________________
  21.  
  22. Ship To (if different from billing address):
  23.  
  24. Name:     ___________________________
  25. Address:  ___________________________
  26. City:     ___________________________   State/Prov.: _____________
  27. Zip:      ___________________________   Country:     _____________
  28.  
  29. Products (Circle all that apply):
  30.  
  31. Product       Version              Key Code   Item Price    Total   
  32. -------------------------------------------------------------------
  33.  
  34. Koohg        1.0.4 for Windows      ______      $19.95      $______ 
  35.  
  36. Strategram   1.0.4 for Windows      ______      $24.95      $______
  37.  
  38. -------------------------------------------------------------------
  39.  
  40. Grand Total:    $ ___________
  41.  
  42. Method of Payment (Check One):
  43.  
  44. __   Cheque   __   Money Order
  45.  
  46.  
  47. Thank you for your order!