Product:  ScrapIt Pro 5.12               Purchase Order     
                                             Date:________
____________________________________________________________________

Name:
[1]
[2]
[3]
Phone/FAX:   [4]       [5]

Email:   [6]

Comments:   [7]  

Payment Method..........:   [8]
Purchase Order #.......:   [9][10][11]

Price per copy................:   $20.00
Number of copies............:   [12]
Quantity Discount...........:   [13]
Send Latest?...(adds $5):   [14]
Disk Size (800k or HD):   [15]
Sales Tax (CA Only).......:   [16]
Note: Sales Tax is only
collected if you've requested
a disk and you live in
California

Total Due.........................:   [17]

[18]
____________________________________________________________________
Please send this form to:

John V. Holder                                                           Email addresses (AOL is preferred):
2862 Lowell Street                                                   America Online:  JohnHolder
Eureka, CA  95501-4315                                         Internet...........:  JohnHolder@aol.com
USA                                                                            CompuServe....:  75040,1126

FAX:  (707) 443-3813