Order Form for ArithmeTick-Tack-Toe =================================== Please make check or money order payable to: NeoPoint Technologies Phone: (204) 668-8180 P.O. Box 2281 FAX: (204) 661-6904 Winnipeg, MB, Canada R3C 4A6 Please send me _______ copy(ies) of ArithmeTick-Tack-Toe at a cost of $15.00 each in US funds. A shipping charge of $2.00 US within Canada and the USA ($5.00 worldwide) will be added to your order. Please call for shipping prices on orders over 5 pieces. Date: ___________________________________________________ Name: ___________________________________________________ Company:___________________________________________________ Address:___________________________________________________ ___________________________________________________ ___________________________________________________ Email: ___________________________________________________ Phone: ___________________ Fax: ________________________ Payment: [ ] Check [ ] Money Order [ ] VISA VISA Orders: Name on card:______________________________________ Card number:_______________________________________ Expiration date:___________________________________ Cardholder's signature: ___________________________ Cardholder will pay to the issuer of the charge card presented herewith the amount stated hereon in accordance with the issuers agreement with the cardholder. I understand that VISA orders will be charged in Canadian funds at the current US-Canadian exchange rate. Your VISA statement will show the charge in your local currency to the approximate equivalent of $15.00 US each + shipping. Where did you obtain this evaluation version? _________________________________________________________ Comments and/or suggestions: _________________________________________________________ _________________________________________________________