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Text File  |  1995-03-08  |  2KB  |  62 lines
  1.                          MILLENNIUM MEDIA GROUP
  2.                                ORDER FORM
  3.                      
  4.  
  5. Name (Please Print) ________________________________________________________
  6. Address ____________________________________________________________________
  7. City __________________________________ State __________ ZIP _______________
  8. Daytime Phone Number (_______)______________________
  9.  
  10.  
  11.                         [ ] Diggers     DOS Floppy                 $39.95
  12.                         [ ] Diggers     DOS CD-ROM                 $49.95
  13.  
  14.                                                     SHIPPING:        5.00
  15.  
  16.                                           PA State Sales Tax:  $____________
  17.                      (PA residents must include 7% sales tax)
  18.                                              Amount enclosed:  $____________
  19.  
  20. Mail or fax this form to:
  21.  
  22.           Millennium Media Group
  23.           234 N. Columbus Blvd.
  24.           Philadelphia, PA  19106
  25.           Fax #:  (215) 625-2567
  26.  
  27. Or call 1-800-U-WANT-IT (1-800-892-6848), for orders only.
  28.  
  29. Type of payment:  [ ] Check  [ ] Visa  [ ] MasterCard
  30.  
  31. Card number: _________________________
  32.  
  33. Expiration date:  _____/_____
  34.  
  35. Signature:   ________________________________________
  36.  
  37.  
  38. Where did you get this DIGGERS Demo from?
  39.  
  40. Downloaded from:
  41. [ ]        Apogee BBS
  42. [ ]        ExecPC BBS
  43. [ ]        Other BBS: Name: ________________________________________________
  44. [ ]        Compuserve (CIS): Forum Name: ___________________________________
  45. [ ]        America Online (AOL)
  46. [ ]        Prodigy
  47. [ ]        Genie: RoundTable  (RT) Name: ___________________________________
  48. [ ]        Delphi: Special Interest Group (SIG) Name: ______________________
  49. [ ]        Internet FTP Site: Site Name: ___________________________________
  50.  
  51. Purchased from:
  52. [ ]        Catalog Vendor: Vendor Name: ____________________________________
  53. [ ]        Retail (Store, flea market, computer fair): 
  54.                                 Vendor Name:  ______________________________
  55. [ ]        Ordered it from MILLENNIUM directly
  56.  
  57. Other:
  58. [ ]        A friend gave it to me
  59. [ ]        Where: __________________________________________________________
  60. [ ]        I don't remember
  61.  
  62.