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Product Order Form

From: 	                                                                                                                                               	Date:

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To: 	

True BASIC Inc.
12 Commerce Avenue, Suite 3
West Lebanon NH  03784-1669  •  800 436-2111  •  24-Fax:  603 298-7015

	Order:	

	____	 QwikCONGRESS™ for Macintosh.   	Item #: 79-015&Q.	    @ 19.00 each :               	________
	
	____	 QwikCONGRESS™	update for registered users*.  #79-015&U:	 @ 9.95 each:     	________

	____	 76-3x10 Labels.   50-sheet pack  (1500 labels).	       @ 8.95 each :                                 	________

* Include Original Disk  Serial No.                                                                 		                        Shipping:	             $5.00

	                                                                                                                                                      Total Enclosed:	    	________



Payment by: 

 [   ] Cash, check or money order;          [   ]Visa;    [   ] MasterCard;   [   ] Discover;   [   ] American Express

	Credit Card Number: ________  ________  ________  ________    	Expiration Date: ________

	Signature: ____________________________



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Copies of  QwikCONGRESS™ are available at special bulk quantity prices for distribution or resale by political or public interest groups. Ask for our current list of Promotional Product Licensing Fees.