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  1.  
  2.           Telix version 3.22                                     #940115-322
  3.           ------------------------------------------------------------------
  4.           Remit to: deltaComm Development, PO Box 1185, Cary, NC  27512  USA
  5.           ------------------------------------------------------------------
  6.           Quan       Item                              US/CDN        Price
  7.  
  8.           ___  Telix Registration................   @ $44/$59 ea   $________
  9.                 (includes serial #, registration +
  10.                   program and manual on disk)
  11.  
  12.           ___  Telix Commercial Version..........   @ $59/$79 ea   $________
  13.                 (same as above, plus 360 page
  14.                   typeset manual & retail packaging)
  15.  
  16.           Disk media:  5.25" [  ]     3.5" [  ]     Low Density [  ]
  17.  
  18.                                                  Volume Discount   $(______)
  19.  
  20.           Single Copy Shipping/Handling is:   ------>   Shipping   $________
  21.           USA:           : $10, via Second Day Air
  22.           Elsewhere      : $10, via Air Mail
  23.  
  24.           Call 800-859-8000 for multiple copy shipping rates
  25.  
  26.                                                         Subtotal   $________
  27.  
  28.            N. Carolina residents please add State Sales Tax (6%)   $________
  29.  
  30.                                                            TOTAL   $________
  31.  
  32.           ------------------------------------------------------------------
  33.           Payment by: ( ) Check or MO  ( ) VISA/MC  ( ) PO # ____________
  34.  
  35.               Name_______________________________________________________
  36.  
  37.            Company_______________________________________________________
  38.  
  39.            Address_______________________________________________________
  40.  
  41.                   _______________________________________________________
  42.  
  43.                       Visa/MC orders will be charged in US currency
  44.               The following information is needed for VISA/MC card payments
  45.  
  46.              Phone(______)________________  Other(______)________________
  47.  
  48.             Card #_______________________________  Expiry date___________
  49.  
  50.           Name of cardholder_____________________________________________
  51.  
  52.           Signature______________________________________________________
  53.                         (VISA/MC orders may also call voice: 800-TLX-8000
  54.                         (VISA/MC orders may also fax:        919-460-4531
  55.