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Text File  |  1992-07-21  |  1KB  |  47 lines
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  7.                                BDEXX ORDER FORM
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  9. Send completed form to:
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  11. Anthony W. Hursh
  12. P.O. Box 141293
  13. Anchorage, AK 99514
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  16.       Item                              Price      Quantity      Amount
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  18. Individual License                       5.00
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  20. Educational License                     25.00
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  22. Per student for Educational Lic.          .10
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  24.                                                            Total:
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  27. Check here for information on the Publisher's License __
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  29. Check here for information on Government License _______
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  33. Your name:    ___________________________
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  35. Organization: ___________________________
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  37. Street:       ___________________________
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  39. City:         ___________________________
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  41. State:        ___________________________
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  43. Zip:          ___________________________
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  45. Telephone:    ___________________________
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