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  1.                          O R D E R    F O R M
  2.  
  3.  Johnathan J. Stein
  4.  STEIN RESEARCH & ENGINEERING                    Voice 419.666.7103
  5.  Post Office Box 346                               Fax 419.874.4922
  6.  Perrysburg, OH  43552                         CompuServe 76576.470
  7.  USA                              INTERNET 76576.470@compuserve.com
  8.  
  9. International Orders:  MasterCard/Visa translates your local currency
  10. to U.S. dollars.  Otherwise, your bank can provide a check in United
  11. States funds.
  12.  
  13.     You can send your order by:
  14.  
  15.     (.) MasterCard/Visa:         Electronic Mail, Telephone or FAX
  16.     ( ) MasterCard/Visa, Check:  Postal Mail
  17.  
  18.     Product                                     Disk Size       Price
  19.                                                 3/5, hi/lo
  20.  
  21.     SHAZAM II - Code & Resource Generator       _________      $99.95
  22.       - for Turbo Vision/Turbo Pascal
  23.  
  24.     Instant INSTALL                             _________      $99.95
  25.       - Software Installation Program
  26.  
  27.     Ye Olde Systeme Editor                      _________      $49.95
  28.       - Deluxe ASCII Editor (w/bonus!)
  29.  
  30.     Overnight Delivery (add $10.00)                          ________
  31.  
  32.                                                      TOTAL   ________
  33.  
  34.           Name ______________________________________________________
  35.  
  36.        Company ______________________________________________________
  37.  
  38.        Address ______________________________________________________
  39.  
  40.           City ______________________________________________________
  41.  
  42. State/Province ___________________ ZIP/Postal Code __________________
  43.  
  44.        Country ____________________ Phone ___________________________
  45.  
  46.          Email ______________________________________________________
  47.  
  48.        Payment ( ) Check                  ( ) MasterCard     ( ) Visa
  49.  
  50.    Card number ______________________________________________________
  51.  
  52.       Exp Date _______________ Signature ____________________________