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Text File  |  1992-04-11  |  2KB  |  60 lines
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  7.                                       ORDER FORM                                      ORDER FORM
  8.                                                               #91-LB120-000
  9.           Remit to:  Micept Instruments Inc.
  10.                      377 Julien St.
  11.                      Cap De La Madeleine, PQ
  12.                      Canada  G8T 6W6                      CIS: [72130,2513]
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  14.           ____ LaserBinder Complete Package........ @ $35.00 ea  $ ________
  15.                (registration, disk and printed manual)
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  17.           ____ LaserBinder Registration ........... @ $25.00 ea  $ ________
  18.                (registration, program and manual on disk)
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  20.           ____ ____________________________________ @ $_____ ea  $ ________
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  22.                Add $6.00 for Shipping and handling ............  $ ________
  23.                (outside North America Add $10.00)
  24.                                                        Subtotal  $ ________
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  26.                                     Residents of Canada Add GST  $ ________
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  28.                                                        Subtotal  $ ________
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  30.                       Quebec residents Add Provincial Sales Tax  $ ________
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  32.                                            Total (U.S. dollars)  $ ________
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  34.                 Payments in Canadian funds: Total (CDN dollars)  $ ________
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  36.                 Exchange rate ______
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  38.                 Payment by:   ( ) Check  ( ) Money Order
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  40.                 Disk format:  ( ) 3 1/2  ( ) 5 1/4
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  42.                   Name:  __________________________________________________
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  44.                Company:  __________________________________________________
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  46.                Address:  __________________________________________________
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  48.                          __________________________________________________
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  50.                          __________________________________________________
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  52.                  Phone:  (day) ________________  (evening) ________________
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  54.                  Signature:  __________________________  Date:  ___________
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  56.                Where did you receive your copy of LaserBinder? (if a BBS
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  58.                give the name and phone number) ____________________________
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  60.                ____________________________________________________________