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Text File  |  1991-03-31  |  5.6 KB  |  80 lines
  1.                            dCOM Order Form
  2. ┌──────────────────────────────────────────────────────────────────────┐
  3. │      Make checks payable to:                          Page 1 of 2    │
  4. │                                                                      │
  5. │                         DAC Micro Systems                            │
  6. │                         40941 176th St E                             │
  7. │                         Lancaster, CA  93535                         │
  8. │                         Voice: 805/264-1700                          │
  9. │                         Data:  805/264-1219                          │
  10. │                                                                      │
  11. │             1 copy                  ___ x $59.00 each  $_____        │
  12. │       2 to  4 copies (10% off)      ___ x $53.00 each  $_____        │
  13. │       5 to  9 copies (20% off)      ___ x $47.00 each  $_____        │
  14. │      10 to 49 copies (30% off)      ___ x $41.00 each  $_____        │
  15. │      50 to 99 copies (40% off)      ___ x $35.00 each  $_____        │
  16. │      100+ copies     (45% off)      ___ x $32.00 each  $_____        │
  17. │                                                                      │
  18. │                                           Subtotal     $_____        │
  19. │                                                                      │
  20. │      California residents please add 7.0% sales tax.   $_____        │
  21. │                                                                      │
  22. │      Shipping and handling - inside the United States   $4.00        │
  23. │                                                         - or -       │
  24. │                            - overseas                   $6.00        │
  25. │                                                                      │
  26. │      Credit Card orders add 3% surcharge               $_____        │
  27. │                                                                      │
  28. │                                                Total   $_____        │
  29. │                                                                      │
  30. │      Diskette type (check or circle one):  [ ] 5.25"  [ ] 3.5"       │
  31. │                                                                      │
  32. │      Processor type (check or circle one):  [ ] IBM   [ ] Z100       │
  33. │                                                                      │
  34. │      Checks & Money Orders must be drawn on US banks in US funds     │
  35. │                                                                      │
  36. │      Payment (check or circle one):                                  │
  37. │                                                                      │
  38. │      [ ] Check  [ ] Money Order  [ ] Visa  [ ] MasterCard            │
  39. │                                                                      │
  40. │      Credit Card #___________________________________________        │
  41. │                                                                      │
  42. │      Expiration Date _______  Signature _____________________        │
  43. │                                                                      │
  44. │      Credit Card Orders may be placed by phone:  805/264-1700        │
  45. │                                                                      │
  46. └──────────────────────────────────────────────────────────────────────┘
  47.  
  48.     dCOM Version ____                             Registration Form
  49. ┌──────────────────────────────────────────────────────────────────────┐
  50. │                                                       Page 2 of 2    │
  51. │                                                                      │
  52. │       Name_______________________________________________________    │
  53. │                                                                      │
  54. │    Company_______________________________________________________    │
  55. │                                                                      │
  56. │    Address_______________________________________________________    │
  57. │                                                                      │
  58. │           _______________________________________________________    │
  59. │                                                                      │
  60. │      Phone_________________________  Bus.________________________    │
  61. │                                                                      │
  62. │   Where did you obtain dCOM?                                         │
  63. │                                                                      │
  64. │           _______________________________________________________    │
  65. │                                                                      │
  66. │   Comments_______________________________________________________    │
  67. │                                                                      │
  68. │           _______________________________________________________    │
  69. │                                                                      │
  70. │           _______________________________________________________    │
  71. │                                                                      │
  72. │           _______________________________________________________    │
  73. │                                                                      │
  74. │           _______________________________________________________    │
  75. │                                                                      │
  76. │           _______________________________________________________    │
  77. │                                                                      │
  78. │                                                                      │
  79. └──────────────────────────────────────────────────────────────────────┘
  80.