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Text File  |  1998-01-29  |  577b  |  24 lines
  1.                             Order Form
  2.  
  3.                   The Psychedelic Screen Saver 3.9
  4.                   The Kinemorphic Screen Saver 2.1
  5.                          CD Spectrum Pro 3.3   
  6.  
  7.           Name:
  8.       Address1:
  9.       Address2:
  10.           City:         State:            Zip:
  11.        Country:
  12.          Phone:
  13.  Email Address:
  14.        Product: [%s]
  15.   
  16. Check payment type:  Visa ___  MasterCard ___ Discover ___  Check/MO ___
  17.  
  18. For credit card orders:
  19.    Name as it appears on card: 
  20.                   Card Number: 
  21.               Expiration date: 
  22.  
  23.  
  24.