Space Madness Order Form

Name: _______________________________________________

Address: ______________________________________________

Address: ______________________________________________

City: ___________________________  State: ________________

Zip Code: ___________________ Country: ____________________

Email or Telephone Number: ________________________________

Serial #: ____________  Do you have a high density floppy drive? ____


Circle One:   Check/Money Order    COD    VISA    MasterCard

VISA/MC Number: _____________________________  Exp: ______

Cardholder’s Name: ______________________________________


____ Space Madness - $35

____ Regular 1st Class U.S. Mail (U.S., Canada, Mexico Only) - Free

____ 2nd Day Priority Mail (U.S. Only) - $1

____ Federal Express Standard Overnight (U.S. Only) - $7

____ Standard Airmail (International, except Canada and Mexico) - $4

____ COD - $3


Make check or money order payable to High Risk Ventures.

Send this completed form with payment to:

High Risk Ventures
PO Box 70690
Eugene, Oregon 97401-9610
USA