Multi Module Music Player Version 1.00 ORDER FORM DISK SIZE: (Check One) [ ]3.5" 1.4M [ ]3.5" 720k [ ]5.4" 1.2M Quantity: payable in U.S. Dollars. MMMP Program... $30.00 x ______ = $___________ Shipping... $7.00 x ______ = $___________ If you use check... $30.00 x ______ = $___________ (commission of bank) Total... $ =========== in Japanese, Yen. MMMP Program... 3,000 yen x ______ = ___________ yen Shipping... 500 yen x ______ = ___________ yen If you use check... 500 yen x ______ = ___________ yen (commission of bank) Total... =========== yen PAYMENT TYPE:(Check One) [ ]AMEX CARD [ ]Bank [ ]Money Ship [ ]CHECK for AMEX form: Cardmember Acct No.__________________________________ Cardmember name______________________________________ Cardmember Valid Dates_______________________________ Cardmember Signature_________________________________ for Bank: In JAPAN. DAIICHI KANGYOU BANK branch No.267(MACHIDA) account No.1970171 account Name:GOLDEN WEEDS PROJECT CO.,LTD. DAIHYOUTORISHIMARIYAKU YAMASAKI YUKINORI phone:(JAPAN)-427-23-0005 for Money ship: for CHECK: Yukinori Yamasaki Golden Weeds Project Co.,Ltd. Peerage AOYAMA5-214 Machida-shi, Nakamachi4-9-8 Tokyo 194, JAPAN Phone (+81)427-39-7672 FAX (+81)427-39-7671 When money ship,within this order form into envelope. Name:__________________________________________________________________ Company:_______________________________________________________________ Street address:________________________________________________________ City:_____________________________________ ZIP code:___________________ Phone:______________________________ FAX:______________________________ Where did you get this program? [ ]BBS [ ]Friend [ ]FTP [ ]other from BBS:(name)_______________________ (ID)_________________________ from FTP site:(name)_______________________ from WEB site:(name)_______________________ other:________________________________ (yours web address)_________________________ (yours E-Mail address)_________________________ What do you use about machine... CPU: [ ]386SX [ ]386DX [ ]486SX [ ]486DX [ ]Pentium [ ]G6 [ ]other__________________________ Cache:_________KB Processor speed:_________MHz RAM:__________MB Harddisk:__________MB Video board: [ ]CGA or lower [ ]EGA [ ]VGA [ ]SVGA [ ]other:_________________________ Video memory:___________KB Sound card: [ ]Sound Blaster [ ]Sound Blaster Pro [ ]Gravis Ultra Sound [ ]Gravis Ultra sound MAX [ ]Gravis Ultra Sound PNP [ ]Pro Audio Spectrum [ ]other__________________________________________________ And any else questions? or request? (If you have many questions, You can send by InterNet-Mail.) (My address is software@gwp3d.com. ) _____________________________________________________________________ Thank you for filling this form out. all text on the check must be in the english language or japanese language. Then this order form send by Air mail or FAX: by airmail... look at upper "PAYMENT TYPE for BANK" for address. by FAX:(+81)-427-39-7671 ex.)from U.S. 011-81-427-39-7672 Golden Weeds Project Co.,Ltd.