home *** CD-ROM | disk | FTP | other *** search
/ Chip 1999 January / Chip_1999-01_cd.bin / sharewar / strtch / ORDERFRM.TXT < prev    next >
Text File  |  1998-03-28  |  3KB  |  57 lines
  1.                        ORDER FORM FOR STRETCH BREAK                             
  2.     ======================================================================
  3.  
  4.     COMPLETE THIS FORM AND SEND WITH CHECK OR MONEY ORDER 
  5.  
  6.                Name:________________________________________
  7.  
  8.             Company:________________________________________
  9.  
  10.      Street Address:________________________________________
  11.  
  12.                     ________________________________________
  13.  
  14.   City, State, ZIP: ________________________________________
  15.  
  16.              Phone: ________________________________________
  17.  
  18.             E-mail: ________________________________________
  19.     -----------------------------------------------------------------
  20.  
  21. ____ STRETCH BREAK @ $24.95      $_______                                  
  22.                                                                              
  23. ____ STRETCH BREAK PRO @ $44.95  $_______  (Contains additional stretches and                                
  24.                                             allows you to select stretches)   
  25.                                                ____________________________  
  26.      California residents please              |                            |
  27.      add 7.75% sales tax:        $_______     | Please make checks         |
  28.                                               | payable to:                |
  29.          Subtotal                $_______     |                            |
  30.                                               | Para Technologies          |
  31.                                               | 3273 Indiana Avenue        |
  32.      Shipping and Handling (USA) $   4.00     | Costa Mesa, CA  92626      |
  33.                                    -------    |                            |
  34.                                               | Voice:  714-546-8619       |
  35.                                               | FAX:    714-546-4607       |
  36.                         Total    $________    |____________________________|
  37.  
  38.                                                                            
  39.          FOR MAIL OR FAX ORDERS WITH MASTER CARD OR VISA                    
  40.  
  41.     Fax them to 714-546-4607 or send in this form with the information below.
  42.  
  43.     Name As It Appears 
  44.     On Credit  Card:__________________________________________
  45.  
  46.     MC/VISA # __________________________________________
  47.  
  48.     MC [ ]  VISA [ ]  (Check one)
  49.  
  50.     Expiration Date ___/___
  51.  
  52.     Signature: _________________________________________ 
  53.  
  54.     You can also place credit card orders by sending the above information 
  55.     by e-mail to paratech@earthlink.net or call in your credit card order 
  56.     to 714-546-8619 between 9am and 7pm Pacific Coast Time. 
  57.