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Text File  |  2000-04-17  |  1.5 KB  |  46 lines
  1. _____________________________________________________________________
  2.  
  3.              Enriva Voyager 98 Order Form
  4.  
  5.             Australia - Aquarian Technologies
  6. _____________________________________________________________________
  7.  
  8.  
  9. Please use this form when ordering by fax or mail:
  10.  
  11. Name        _____________________________________________
  12. Company     _____________________________________________
  13. Address     _____________________________________________
  14.             _____________________________________________
  15. City/Town   _____________________________________________
  16. Country     _______________________   Post Code ___________
  17. Telephone   ________________________________
  18. EMail       ________________________________
  19.  
  20.                    [ ] Cheque   [ ] Money Order
  21.                    [ ] BankCard [ ] VISA [ ] MasterCard
  22.  
  23. Name on Card    _______________________________________
  24.                     (Only if different from Name above)
  25.  
  26. Credit Card Number ____________________________________
  27.  
  28. Expiration Date  _____ /_____
  29.  
  30. Signature   _______________________
  31.  
  32. ____ Copies of Enriva Voyager 98 @ $AUD 49.95 = $_______
  33.  
  34.  
  35. Where did you hear about Enriva Voyager?
  36. _______________________________________________________
  37.  
  38. What new features would you like to see ?
  39. _______________________________________________________
  40. _______________________________________________________
  41. _______________________________________________________
  42.  
  43.  
  44. Please make cheques payable to: Aquarian Technologies.
  45.  
  46.