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Text File  |  1993-09-29  |  3KB  |  54 lines
  1.                                  ORDER FORM
  2.  
  3.  To:   ARK ANGLES                                         Phone: (047) 588100
  4.        24 Alexander Ave                                     Intl+61-47-588100
  5.        Hazelbrook  NSW  2779                              Fax:   (047) 588638
  6.        AUSTRALIA                                            Intl+61-47-588638
  7.  
  8.  From: Name    ______________________________________________________________
  9.  
  10.        Company ______________________________________________________________
  11.  
  12.        Address ______________________________________________________________
  13.  
  14.        Town    _____________________________  State _________  Code _________
  15.  
  16.        Country ______________________________________________________________
  17.  
  18.        Phone   _____________________________  Fax ___________________________
  19.  
  20.  Where did you obtain the program(s)? _______________________________________
  21.  
  22.  Computer:   [ ] XT   [ ] AT/286   [ ] 386SX   [ ] 386DX   [ ] 486   [ ] >486
  23.  
  24.  Memory Size: ____________   Hard Disk Size: __________
  25.  
  26.  Floppies:   [ ] 5.25" 360K   [ ] 5.25" 1.2M   [ ] 3.5" 720K   [ ] 3.5" 1.44M
  27.  
  28.  Screen:    [ ] Mono    [ ] Herc    [ ] CGA    [ ] EGA    [ ] VGA    [ ] >VGA
  29.  
  30.  Dos Version: ________   Windows Version: _________   OS/2 Version: _________
  31.   _____________________________________________________ ________ ___________
  32.  | P R O D U C T  /  L I C E N S E                     | Q T Y  | P R I C E |
  33.  |_____________________________________________________|________|___________|
  34.  |                                                     |        |           |
  35.  |_____________________________________________________|________|___________|
  36.  |                                                     |        |           |
  37.  |_____________________________________________________|________|___________|
  38.  |                                                     |        |           |
  39.  |_____________________________________________________|________|___________|
  40.  |                                                     |        |           |
  41.  |_____________________________________________________|________|___________|
  42.  | Shipping                                                     |     $5.00 |
  43.  |______________________________________________________________|___________|
  44.  | T O T A L                                                    |           |
  45.  |______________________________________________________________|___________|
  46.  
  47.  [ ] Bankcard   [ ] Mastercard   [ ] Visa   [ ] Cash/Cheque/Draft/Money Order
  48.  
  49.  Credit Card Number _______ _______ _______ _______   Expiry Date ____ / ____
  50.  
  51.  Cardholders Name   _________________________________________________________
  52.  
  53.  Signature          _______________________________   Date __________________
  54.