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  1. ********************************************************************************
  2. *                                                                              *
  3. *                          CHAMPROGRAMMING ORDER FORM                          *
  4. *                                                                              *
  5. ********************************************************************************
  6.  
  7. 1. NAME AND ADDRESS:                       3. CLASSIC GAMES WISH LIST:
  8.  
  9. ______________________________________         1. ____________________________
  10.  
  11. ______________________________________         2. ____________________________
  12.  
  13. ______________________________________         3. ____________________________
  14.  
  15. Phone: (______)____________ Age: _____         4. ____________________________
  16.  
  17. Email: _____________@_________________         5. ____________________________
  18.  
  19.  
  20. 2. HARDWARE PROFILE:                       4.  HOW WERE YOU INTRODUCED TO
  21.    (Describe your computer system)             CHAMPROGRAMMING?
  22.  
  23. Processor (386/486/Pentium): _________         _______________________________
  24.                                               
  25.       Do you use a joystick? _________     5.  WHAT DO YOU LIKE MOST ABOUT
  26.                                                CHAMP GAMES?
  27.    Do you have a sound card? _________         
  28.                                                _______________________________                                                                                                                          ( List your favorite games )
  29.  
  30. 6. ORDER INFORMATION:
  31.  
  32.  Quantity  Item Code         Item Description            Unit Price Total Price
  33.  ______________________________________________________________________________
  34. |        |   CG05    |   CHAMP KONG                     |  17.95   |           |
  35. |________|___________|__________________________________|__________|___________|
  36. |        |   CG00    |   CHAMP CABLE                    |  17.95   |           |
  37. |________|___________|__________________________________|__________|___________|
  38. |        |   CG04    |   CHAMP MS. PAC-EM               |  17.95   |           |
  39. |________|___________|__________________________________|__________|___________|
  40. |        |   CG01    |   CHAMP PAC-EM                   |  12.95   |           |
  41. |________|___________|__________________________________|__________|___________|
  42. |        |   CG02    |   CHAMP CENTIPEDE                |  12.95   |           |
  43. |________|___________|__________________________________|__________|___________|
  44. |        |   CG03    |   CHAMP ASTEROIDS                |  12.95   |           |
  45. |________|___________|__________________________________|__________|___________|
  46.    ********************************                                |           |
  47.    *    SATISFACTION GUARANTEED   *                      Subtotal: |___________|
  48.    *                              *                                |           |
  49.    * If, for any reason, you are  *     (CT Residents add 6%) Tax: |___________|
  50.    *   not satisfied, write our   *                                |           |
  51.    * Customer Service Department  *                      Shipping: |___________|
  52.    ********************************                                |           |
  53.                                                             Total: |___________|
  54.    Shipping and Handling:
  55.    -> $2 for first item + $1 for each additional item.
  56.    -> All merchandise will be shipped within 1-2 weeks of purchase!
  57.  
  58.    Send to: CHAMProgramming Inc.
  59.             34-3 Shunpike Road,                        
  60.             Cromwell, CT 06416                        THANK YOU FOR YOUR ORDER!
  61.