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  1.                     ┌──────────────────────────────┐
  2.                     │ BSX International Order Form │
  3.                     └──────────────────────────────┘
  4.        I wish to register or purchase the following BSX products:
  5.  
  6.                                                        Register  or   Disk
  7.                                                         Purchase ?    size
  8.                                                           Circle      for
  9.                                                            one:    Purchases:
  10.  
  11.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  12.  
  13.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  14.  
  15.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  16.  
  17.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  18.  
  19.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  20.  
  21.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  22.  
  23.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  24.  
  25.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  26.  
  27.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  28.  
  29.   ___ copies of ____________,  @ $______ each: $______  Reg / Pur  5.25 / 3.5
  30.  
  31.                                For a total of: $______
  32.  
  33.   I've enclosed a check or money order payable to Robert Roberds.
  34.  
  35.   Please ship purchased products to:
  36.                                                              (Please print)
  37.   Name:_____________________________________________________
  38.  
  39.   Street Address:___________________________________________
  40.  
  41.   City, State/Province:_____________________________________
  42.  
  43.   Zip Code:_____________     Country:_______________________
  44.  
  45.   Phone (Optional):_________________________
  46.  
  47.  
  48.   I understand that registered products are  not  to  be  delivered,  while
  49.   purchased products are.
  50.  
  51.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  52.  
  53.            Send this form along with cash, check or money order
  54.                       PAYABLE TO ROBERT ROBERDS
  55.                                  to:
  56.  
  57.                      ┌──────────────────────────┐
  58.                      │BSX International         │
  59.                      │806 Park Ridge Rd. Apt. A8│
  60.                      │Durham, NC 27713          │
  61.                      └──────────────────────────┘
  62.  
  63.        *** PLEASE MAKE THE CHECK PAYABLE TO: ROBERT ROBERDS ***
  64.        *** DO NOT MAKE IT PAYABLE  TO  BSX INTERNATIONAL!!! ***
  65.        ***   DON'T  ***   EVEN   ***    THINK    ***   IT   ***
  66.  
  67.  
  68.  
  69.        Please allow 1-2 weeks for delivery of purchases. Thanks!
  70. This form is optional.  If you just send money, that's cool.  Real cool.
  71.