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Text File  |  1995-06-22  |  3KB  |  68 lines
  1. Order Form
  2. Prices good through 12/96, subject to change thereafter.
  3.  
  4. __________________________________________________________________________
  5. (Name)
  6.  
  7. __________________________________________________________________________
  8. (Company)
  9.  
  10. __________________________________________________________________________
  11. (Street1)
  12.  
  13. __________________________________________________________________________
  14. (Street2)
  15.  
  16. __________________________________________________________________________
  17. (Town)                                   (State)              (Zip)
  18.  
  19. __________________________________________________________________________
  20. (Telephone)                   (Fax)               (Country if outside USA)
  21.  
  22. Shipping is $4.00 for your entire order, whether you order 1 or 100 items.
  23.  
  24.  
  25.  QUANTITY  ITEM                               PRICE EACH          TOTAL
  26. --------------------------------------------------------------------------
  27.            The Lights Go Down 3.5" diskette   US  $25.00    US$
  28. --------------------------------------------------------------------------
  29.            The Lights Go Down 5.25" diskettes US  $27.00    US$
  30. --------------------------------------------------------------------------
  31.            Shipping                           US  $ 4.00    US$   4.00
  32. --------------------------------------------------------------------------
  33.            TAX  (NYS residents only)               ___ %    US$
  34. --------------------------------------------------------------------------
  35.                                                   TOTAL:    US$
  36.                                                           ================
  37. Prices good through 12/96, subject to change thereafter.
  38. I am paying by:
  39. ( ) CHECK     ( ) VISACARD    ( ) MASTERCARD     ( ) AMERICAN EXPRESS
  40. ( ) CASH  (by registered mail only, please)      ( ) DISCOVER CARD
  41.  
  42.                      Number ______-______-______-______  Exp. date ___-___
  43.  
  44. ________________________________________________      ______-______-______
  45. (Signature)                                           (Date)
  46.  
  47. We would appreciate it if you would tell us where did you first hear about this program. Thanks for your 
  48. cooperation.
  49. [] BBS - which one?______________________________________
  50. [] Friend    [] retail store package    [] CD-ROM
  51. [] magazine - which one?_________________________________
  52. [] other - ______________________________________________
  53.  
  54.  
  55.  
  56. Send your order to
  57.      Pik A Program (tm)
  58.      13 Saint Marks Place
  59.      NY, NY  10003
  60.      USA
  61.      
  62.      TOLL FREE (ORDERS ONLY) 1-800-TOREGISTER  (1-800-867-3447)
  63.      Telephone (212) 598-4939, Fax (212) 228-5879
  64.      Compuserve: 74777,3233 (GO PIKAPRO)
  65.      Internet: 74777.3233@compuserve.com
  66.  
  67. Please make your check or postal order payable to Pik A Program
  68.