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Text File  |  1993-03-19  |  3.2 KB  |  72 lines
  1. Modem Base Pro Release 1.x Order Form
  2. -------------------------------------
  3.  
  4. You may use your Credit Card for next day shipping by calling our sales
  5. department at 800-633-6636 (9am-6pm PST) or complete and mail in the form
  6. below to the following address :
  7.  
  8.         Integrated Solutions
  9.         Attention: MODEM BASE PRO SALES
  10.         2995 Van Buren Blvd
  11.         MAIL STOP: A-13-189
  12.         Riverside, CA 92503
  13.  
  14. Make all money orders, cashiers checks, company and personal checks payable
  15. to: INTEGRATED SOLUTIONS
  16.  
  17. ---------------------------------------------------------------------------
  18.    Introductory Test Drive Price of $99.00, retail value is $249.00
  19. ---------------------------------------------------------------------------
  20.                     (Offer Good until April 31, 1993)
  21.  
  22. FULL NAME:______________________________________________________________
  23.   COMPANY:______________________________________________________________
  24.   ADDRESS:______________________________________________________________
  25.      CITY:______________________________________________________________
  26.     STATE:______________________________________________________________
  27.   COUNTRY:______________________________________________________________
  28.       ZIP:______________________________________________________________
  29.  
  30. TELEPHONE:_______________________  BBS PHONE:___________________________
  31.       FAX:_______________________   BBS NAME:___________________________
  32.  
  33. SYSOP NAME IF DIFFERENT FROM PURCHASER:_________________________________
  34.  
  35. The following information is optional, but helps assist us in knowing
  36. more about our customer base.
  37.  
  38. BBS SOFTWARE:___________________________________________________________
  39.   # OF LINES:_________________   YEARS ON-LINE:_________________________
  40.  
  41. ----------------------------------------------------------------------------
  42. ORDER WORKSHEET:
  43. ----------------------------------------------------------------------------
  44. QUANTITY        PRODUCT                 UNIT COST       EXT.COST
  45. -----------------------------------------------------------------
  46. ___             MODEM BASE PRO 1.x        $99.00
  47.  
  48.                                             SUBTOTAL:
  49.                                             (CA) TAX:
  50.                       FEDERAL EXPRESS 2-DAY SHIPPING:    $12.50
  51.                                                TOTAL:
  52. CA residents add sales tax.
  53. Make Checks payable to: INTEGRATED SOLUTIONS.
  54. (Personal Checks allow up to 2 weeks for delivery, for faster response send
  55. a cashiers check or money order, government purchase orders excepted, call
  56. 800-633-6636 or use your credit card - see below.)
  57.  
  58. I have enclosed the following amount $______________.
  59.  
  60. Credit Card Orders:
  61. -------------------
  62. Which Credit Card?  [ ] VISA    [ ] MASTERCARD
  63.  
  64.    Cardholder:______________________________________
  65. Credit Card #:______________________________________
  66.    Expiration:______________________________________
  67. Please Charge my Credit Card the following amount: $_____________________.
  68.     Signature:______________________________________  Date:______________
  69.  
  70. Please rush me my order of Modem Base Pro Commercial Release.
  71. ----------------------------------------------------------------------------
  72.