Form Page 4

This is an explanation of the purpose of the form ...

  1. Please provide the following contact information:
    Name
    Title
    Organization
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail
    URL
  2. Please provide the following ordering information:
    QTY DESCRIPTION
    BILLING
    Credit card
    Cardholder name
    Card number
    Expiration date
    SHIPPING
    Street address
    Address (cont.)
    City
    State/Province
    Zip/Postal code
    Country
  3. Please provide the following product information:
    Product name
    Model
    Version number
    Operating system

Copyright information goes here.
Last revised: November 12, 1998

 

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Copyright © 1998 Signature Graphics Co
Last modified: November 12, 1998