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  1.                        WinSysEx Order Form
  2.  
  3.  
  4. Name:    __________________________________________
  5.  
  6. Address: __________________________________________
  7.  
  8.      __________________________________________
  9.  
  10.      __________________________________________
  11.  
  12.  
  13. CompuServe UserID, if applicable: _________________
  14.  
  15.  
  16.  
  17. ITEM                                   PRICE    UNITS   AMOUNT
  18.  
  19. WinSysEx registration                  $39.00   _____   ______
  20.  
  21. If you don't live in the United States,
  22. Canada, or Mexico, add $5.00 for mailing.               ______
  23.  
  24. Sales Tax (New York State residents only)
  25.        County____________ Rate_______%          Tax:    ______
  26.  
  27.                         TOTAL:  ______
  28.  
  29.  
  30. Print this order form, and send the form and your payment to:
  31.  
  32. Rochester Heritage
  33. 72 Knapp Ave.
  34. Rochester, NY 14609-1127
  35.  
  36. Include any comments or suggestions you have about the program.
  37.  
  38. Thank you very much for the order!
  39.