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Fax: (514) 642-6480
International: +1 514 642 6480

Mail:
Just Logic Technologies Inc.
P.O. Box 63050,  40 Commerce St.,
Nun's Island, QC, H3E 1V6
Canada

Name: ________________________________________________

Company: _____________________________________________

Street Address (no P.O. Box Please):

      ________________________________________________

      ________________________________________________

City: _________________ State or Province: ___________

Zip or Postal Code: ______ Country: __________________

Daytime Phone Number (required): _____________________

Fax: ________________ E-mail: ________________________

Product: _____________________________ Price: ________

         _____________________________ Price: ________

Shipping and Handling:                        ________
($10 in USA and Canada, $25 Express
$35 to other countries)

Tax (Canada: 7% GST, Quebec 6.5% PST):        ________

Total:                                        ________

Credit Card:
Visa   MasterCard, EuroCard   American Express 

Card Number: __________________ Expiration Date: _____

Name on Card:  same as above or: ____________________

Signature: ___________________________________________


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Last modification: 10/96