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  1.                         BSX International Order Form
  2.  
  3.         I wish to register or purchase the following BSX products:
  4.  
  5.                                                          Register  or  Disk
  6.                                                           Purchase ?   size
  7.                                                             Circle     for
  8.                                                              one:   Purchases:
  9.  
  10.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  11.  
  12.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  13.  
  14.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  15.  
  16.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  17.  
  18.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  19.  
  20.   ___ copies of ______________,  @ $______ each: $______  Reg / Pur 5.25 / 3.5
  21.  
  22.                                  For a total of: $______
  23.  
  24.   I've enclosed a check or money order payable to Robert Roberds.
  25.  
  26.   Please ship purchased products to:
  27.                                                              (Please print)
  28.   Name:_____________________________________________________
  29.  
  30.   Street Address:___________________________________________
  31.  
  32.   City, State/Province:_____________________________________
  33.  
  34.   Zip Code:_____________     Country:_______________________
  35.  
  36.   Phone (Optional):_________________________
  37.  
  38.  
  39.   I understand that registered products are  not  to  be  delivered,  while
  40.   purchased products are.
  41.  
  42.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  43.  
  44.              Send this form along with check or money order to:
  45.  
  46.                             BSX International
  47.                             806 Park Ridge Rd. Apt. A8
  48.                             Durham, NC 27713
  49.  
  50.             Please allow 1-2 weeks for delivery of purchases. Thanks!
  51.