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Text File  |  1996-07-31  |  3KB  |  54 lines
  1. ===============================================================================
  2.                               O R D E R    F O R M
  3. ===============================================================================
  4.  
  5. First Name ____________________________ Last Name _____________________________
  6.  
  7. Company    ____________________________________________________________________
  8.  
  9. Address1   ____________________________________________________________________
  10.  
  11. Address2   ____________________________________________________________________
  12.  
  13. City/Town  ____________________________________________________________________
  14.  
  15. State      _______  Zip Code  ______________  Country _________________________
  16.  
  17. Day Phone   ____________________________ Fax # ________________________________
  18.  
  19. Credit Card; Master Card [ ], Visa [ ], American Express [ ], Discover [ ]
  20.  
  21.           Card #    _____________________________________________ EX ____/_____
  22.  
  23.           Signature ___________________________________________________________
  24.  
  25. Check [ ];  Please remit in U.S. funds drawn on a U.S. Bank.
  26.  
  27.                                                              Shipping
  28. Quan                 Description                     Price  (USA/ Int)  Total
  29.  
  30. ____ PowerBASIC Gazette                                $0    $0   $0      $0
  31. ____ PowerBASIC 3 Demo (TRYPB3.EXE)                    $0    $0   $0      $0
  32. ____ FirstBasic Registered Version                  $ 25.00  $4 / $10  ________
  33. ____ PowerBASIC 3 for DOS                           $149.00  $6 / $28  ________
  34.  
  35. ____ PowerBASIC Developer Kit for Windows           $149.00  $6 / $28  ________
  36. ____ PB/Xtra  (Programmer's Reference Collection)   $ 49.00  $4 / $10  ________
  37.      CDROM ____   3.5 inch disks ____
  38. ____ QuickPak Professional for PowerBASIC           $129.00  $6 / $28  ________
  39. ____ SoftCode for PowerBASIC (Code Generator)       $ 99.00  $6 / $28  ________
  40. ____ SoftDemo and Flash-up Toolbox                  $ 49.00  $4 / $10  ________
  41.  
  42. Total                                                                  ________
  43.  
  44. Priority Shipping (USA Only)
  45.         [__] Overnight add $16.00, [__] Second Day add $6.00           ________
  46.  
  47.         [__] COD's (USA Only) Add $5.00                                _________
  48.  
  49.         Sales Tax (California Residents Only) @ 7.25%                  ________
  50.                                                                                                                                          Total _________
  51.            PowerBASIC, Inc., 316 Mid Valley Center, Carmel, CA 93923
  52.          408-659-8000 voice, 408-659-8008 Fax, 800-780-7707 orders only
  53.               75300,1742 CompuServe, sales@powerbasic.com Internet
  54.