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Text File  |  1996-09-15  |  2KB  |  47 lines
  1. ORDER FORM *** ITGraph(tm) by INDRA Technology, Inc.
  2.  
  3. THANK YOU FOR PURCHASING THE ITGraph(tm) VBX.  
  4. PLEASE PROVIDE ALL INFORMATION REQUESTED BELOW.
  5.  
  6. ITGraph 1.2 VBX .......................$79.95
  7. [ ] Sales Tax (CA Residents Only) ..... $5.60
  8. Shipping & Handling:
  9.         [ ] US 1st Class ........$5.00
  10.         [ ] US 2nd Day Air .....$10.00
  11.         [ ] US Next Day Air ....$15.00
  12.         [ ] International Air ..$10.00 _______
  13.  
  14. TOTAL ................................ _______
  15.  
  16. ENTER SHIPPING ADDRESS BELOW:
  17.         NAME:___________________________________________________
  18.         COMPANY:________________________________________________
  19.         ADDRESS:________________________________________________
  20.                 ________________________________________________
  21.         CITY:________________________  STATE:____ ZIP:__________
  22.  
  23.         PHONE:(_____)______________ EXT__________
  24.         FAX:(_____)________________ EMAIL:______________________
  25.  
  26. PAYMENT METHOD (Please Indicate Choice):
  27.         [ ]CREDIT CARD (Check One):
  28.             [ ]VISA     [ ]MASTERCARD    [ ]AMERICAN EXPRESS
  29.             CARDHOLDER*:_____________________________________
  30.             CARD NUMBER:_____________________________________
  31.             EXPIRATION DATE:_______________
  32.             *Please copy exactly as appears on credit card.
  33.         [ ]CHECK**
  34.         [ ]MONEY ORDER**
  35.             **Please make payable to Indra Technology, Inc.
  36.  
  37. FAX TO: (619) 558-1760
  38. OR MAIL TO:
  39.         Indra Technology, Inc.
  40.         6160 Lusk Blvd, Suite C-203
  41.         San Diego, CA 92121
  42.         Attn: ITGraph Order
  43.  
  44. THANKS AGAIN FOR YOUR ORDER!
  45.  
  46. *** Phone Orders: Call (800)735-7776 or (619)452-2652 ***
  47.